Every year in the world, 4 million children die before the age of one, mainly in resource-limited countries, one-third of them due to a severe infection. The neonatal period alone (first month of life) accounts for one third of deaths before the age of one. This situation is all the more complex in a context of ever-increasing emergence of antibiotic-resistant bacteria. In 2012, the Institut Pasteur and Institut Pasteur de Madagascar initiated the BIRDY program1 with the aim of documenting neonatal infections in the community and assessing the state of antibiotic resistance.
Gathered at the Institut Pasteur de Madagascar on February 14th and 15th, the researchers revealed thet results obtained from the first 981 children included in this program, which began in 2012. A total of 394 newborns were followed on an urban site in Antananarivo and 587 in a semi-rural area in Moramanga. All babies received active follow-up during their first month of life (regular home visit) and rapid care in case of suspected infection.
Incidence of neonatal infections 40 times greater than in the United States
The first results show an incidence of confirmed neonatal infections of 17.7 per 1000 live births. This rate rises even up to 35.8 per 1000 by adding the cases of probable neonatal infections2, an extremely high incidence, 40 times higher than that observed in the United States. The researchers also found that 75% of these infections occur during the first week of life. "Our results underscore the importance of strengthening follow-up and management around childbirth at the community level. One must bear in mind that more than one-third of the women in our cohort delivered at home," says Bich-Tram Huynh, researcher in the Pharmacoepidemiology and Infectious Diseases Unit of the Institut Pasteur and co-principal investigator of the BIRDY program.
Babies included in the cohort benefit from regular home visits and are taken care of in case of suspected infection. Credit: Institut Pasteur de Madagascar/Sophie Goyet
The incidence of multidrug-resistant bacterial infections has been estimated at 7.7 cases per 1000 live births. "This is the first time ever that this rate is estimated in a community setting. These preliminary results are relatively moderate compared to what we expected. If they are confirmed, it means there is still time to implement interventions to limit the spread of these multidrug-resistant bacteria in the community" comments Jean-Marc Collard, Head of the Experimental Bacteriology Unit at the Institut Pasteur de Madagascar and co-principal investigator of the BIRDY program. However, bacteriological analyzes showed that 70% of pathogens found in neonates were resistant to at least one of the two antibiotics currently recommended by the World Health Organization to treat these infections (ampicillin and gentamicin).
During the restitution meeting, the researchers announced the launch of a BIRDY 2 project which will start in the second half of 2018 for a period of 3 years. This new project will implement a One Health approach to globally study the transmission of multidrug-resistant bacteria. "We will refine our estimate of the incidence of neonatal infections and study the acquisition of multidrug-resistant bacteria in neonates, whether from the mother or the environment. We will also look at prematurity to try to understand what triggers it and what are the consequences for the development of the child, "explains Perlinot Herindrainy, program coordinator and epidemiologist at the Institut Pasteur de Madagascar. Indeed, complications due to premature birth are responsible for more than 27% of newborn deaths.
Unique in its approach and scope, this study is also being implemented since 2014 in Cambodia and Senegal identically to Madagascar in partnership with local Institut Pasteur. It will ultimately provide comparable results in different local contexts.
The BIRDY project is supported in Madagascar by the International Cooperation Department of the Principality of Monaco
(1) Bacterial Infections and antibiotic Resistant Diseases among Young children in low income countries
(2) probable cases are neonates with clinical symptoms of severe infection and for whom perinatal specimens (ears, feces, placenta, gastric fluid) have been shown to be positive. The confirmed cases are neonates with clinical symptoms of severe infection and for whom the central samples (blood, cerebrospinal fluid, urine) have been positive.