Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 2/2015

Open Access 01-12-2015 | Research

Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions

Authors: Aline Simen-Kapeu, Anna C Seale, Steve Wall, Christabel Nyange, Shamim A Qazi, Sarah G Moxon, Mark Young, Grace Liu, Gary L Darmstadt, Kim E Dickson, Joy E Lawn

Published in: BMC Pregnancy and Childbirth | Special Issue 2/2015

Login to get access

Abstract

Background

Around one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity.

Methods

A standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections.

Results

For neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges.

Conclusions

Rapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups.
Appendix
Available only for authorised users
Literature
1.
Lawn JE, Blencowe H, Oza S, You D, Lee AC, Waiswa P, et al: Every Newborn: progress, priorities, and potential beyond survival. Lancet. 2014, 384 (9938): 189-205. 10.1016/S0140-6736(14)60496-7.CrossRefPubMed
2.
Seale AC, Blencowe H, Manu AA, Nair H, Bahl R, Qazi SA, et al: Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis. The Lancet infectious diseases. 2014, 14 (8): 731-741. 10.1016/S1473-3099(14)70804-7.CrossRefPubMedPubMedCentral
3.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al: Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012, 380 (9859): 2197-2223. 10.1016/S0140-6736(12)61689-4.CrossRefPubMed
4.
Waters D, Jawad I, Ahmad A, Luksic I, Nair H, Zgaga L, et al: Aetiology of community-acquired neonatal sepsis in low and middle income countries. Journal of global health. 2011, 1 (2): 154-170.PubMedPubMedCentral
5.
Thaver D, Zaidi AK: Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J. 2009, 28 (1 Suppl): S3-9.CrossRefPubMed
6.
African Neonatal Sepsis Trial group, Tshefu A, Lokangaka A, Ngaima S, Engmann C, Esamai F, et al: Oral amoxicillin compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with fast breathing when referral is not possible: a randomised, open-label, equivalence trial. Lancet. 2015, 385 (9979): 1758-1766. 10.1016/S0140-6736(14)62285-6.CrossRef
7.
African Neonatal Sepsis Trial group, Tshefu A, Lokangaka A, Ngaima S, Engmann C, Esamai F, et al: Simplified antibiotic regimens compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with clinical signs of possible serious bacterial infection when referral is not possible: a randomised, open-label, equivalence trial. Lancet. 2015, 385 (9979): 1767-1776. 10.1016/S0140-6736(14)62284-4.CrossRef
8.
Baqui AH, Saha SK, Ahmed AS, Shahidullah M, Quasem I, Roth DE, et al: Safety and efficacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open-label, equivalence trial. The Lancet Global health. 2015, 3 (5): e279-287. 10.1016/S2214-109X(14)70347-X.CrossRefPubMed
9.
Dickson KE, Simen-Kapeu A, Kinney MV, Huicho L, Vesel L, Lackritz E, et al: Every Newborn: health-systems bottlenecks and strategies to accelerate scale-up in countries. Lancet. 2014, 384 (9941): 438-454. 10.1016/S0140-6736(14)60582-1.CrossRefPubMed
10.
Baqui AH, El-Arifeen S, Darmstadt GL, Ahmed S, Williams EK, Seraji HR, et al: Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial. Lancet. 2008, 371 (9628): 1936-1944. 10.1016/S0140-6736(08)60835-1.CrossRefPubMed
11.
Herbert HK, Lee AC, Chandran A, Rudan I, Baqui AH: Care seeking for neonatal illness in low- and middle-income countries: a systematic review. PLoS medicine. 2012, 9 (3): e1001183-10.1371/journal.pmed.1001183.CrossRefPubMedPubMedCentral
12.
Bahl R, Martines J, Ali N, Bhan MK, Carlo W, Chan KY, et al: Research priorities to reduce global mortality from newborn infections by 2015. Pediatr Infect Dis J. 2009, 28 (1 Suppl): S43-48.CrossRefPubMed
13.
14.
Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, De Bernis L: Evidence-based, cost-effective interventions: how many newborn babies can we save?. Lancet. 2005, 365 (9463): 977-988. 10.1016/S0140-6736(05)71088-6.CrossRefPubMed
15.
Edmond K, Zaidi A: New approaches to preventing, diagnosing, and treating neonatal sepsis. PLoS medicine. 2010, 7 (3): e1000213-10.1371/journal.pmed.1000213.CrossRefPubMedPubMedCentral
16.
Dickson Kim, Kinney Mary, Moxon Sarah, Ashton Joanne, Zaka Nabila, Simen-Kapeu Aline, Sharma Gaurav, Kerber Kate, Daelmans Bernadette, Gülmezoglu Metin A, Mathai Matthews, Nyange Christabel, Baye Martina, Lawn Joy: Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions. BMC Pregnancy Childbirth. 2015, 15 (Suppl 2): S1-CrossRefPubMedPubMedCentral
17.
WHO, UNICEF: Every Newborn Action Plan: Progress Report May 2015. World Health Organization; United Nations Children's Fund. 2015
18.
Singh D, Lample M, Earnest J: The involvement of men in maternal health care: cross-sectional, pilot case studies from Maligita and Kibibi, Uganda. Reprod Health. 2014, 11: 68-10.1186/1742-4755-11-68.CrossRefPubMedPubMedCentral
19.
Plantin L, Olukoya A, Pernilla N: Positive health outcomes of fathers' involvement in pregnancy and childbirth paternal support: a scope study literature review. Fathering A Journal of Theory Research and Practice about Men as Fathers. 2011, 9 (1): 87-102. 10.3149/fth.0901.87.CrossRef
20.
Gogia S, Ramji S, Gupta P, Gera T, Shah D, Mathew JL, et al: Community based newborn care: a systematic review and metaanalysis of evidence: UNICEF-PHFI series on newborn and child health, India. Indian Pediatr. 2011, 48 (7): 537-546. 10.1007/s13312-011-0096-8.CrossRefPubMed
21.
Bhandari N, Mazumder S, Taneja S, Sommerfelt H, Strand TA, Group IES: Effect of implementation of Integrated Management of Neonatal and Childhood Illness (IMNCI) programme on neonatal and infant mortality: cluster randomised controlled trial. BMJ. 2012, 344: e1634-10.1136/bmj.e1634.CrossRefPubMedPubMedCentral
22.
Healy CM, Baker CJ: Maternal immunization. Pediatr Infect Dis J. 2007, 26 (10): 945-948. 10.1097/INF.0b013e318156c18c.CrossRefPubMed
23.
Dawson P, Pradhan Y, Houston R, Karki S, Poudel D, Hodgins S: From research to national expansion: 20 years' experience of community-based management of childhood pneumonia in Nepal. Bull World Health Organ. 2008, 86 (5): 339-343. 10.2471/BLT.07.047688.CrossRefPubMedPubMedCentral
24.
Enweronu-Laryea Christabel, Dickson Kim, Moxon Sarah, Simen-Kapeu Aline, Nyange Christabel, Niermeyer Susan, Bégin France, Sobel Howard, Lee Anne, von Xylander Ritter Severin, Lawn Joy: Basic newborn care and neonatal resuscitation: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth. 2015, 15 (Suppl 2): S4-CrossRefPubMedPubMedCentral
25.
Sharma Gaurav, Mathai Matthews, Dickson Eva Kim, Weeks Andrew, Hofmeyr Justus G, Lavender Tina, Day Tina Louise, Mathews Elizabeth Jiji, Fawcus Sue, Kapeu Simen Aline, de Bernis Luc: Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth. 2015, 15 (Suppl 2): S2-CrossRefPubMedPubMedCentral
26.
Zaidi AK, Ganatra HA, Syed S, Cousens S, Lee AC, Black R, et al: Effect of case management on neonatal mortality due to sepsis and pneumonia. BMC Public Health. 2011, 11 (Suppl 3): S13-10.1186/1471-2458-11-S3-S13.CrossRefPubMedPubMedCentral
27.
UNICEF: Management of sick children by community health workers: Intervention models and programme examples. 2006, United Nation's Children's Fund and World Health Organization
28.
Waiswa P, Kallander K, Peterson S, Tomson G, Pariyo GW: Using the three delays model to understand why newborn babies die in eastern Uganda. Trop Med Int Health. 2010, 15 (8): 964-972. 10.1111/j.1365-3156.2010.02557.x.CrossRefPubMed
29.
Olaniran N, Offiong S, Ottong J, Asuquo E, Duke F: Mobilizing the community to utilize obstetric services, Cross River State, Nigeria. International Journal of Gynecology and Obstetrics. 1997, 59 (Suppl 2): S181-S189.CrossRefPubMed
30.
Maiga Z, Traore NF, El Abassi A: La réforme du secteur santé au Mali (1989-1996). Studies in Health Services Organisation & Policy 12. 1999, ITGPress, Antwerpen
31.
Knippenberg R, Lawn JE, Darmstadt GL, Begkoyian G, Fogstad H, Walelign N, Paul VK: Systematic scaling up of neonatal care in countries. Lancet. 2005, 365 (9464): 1087-1098. 10.1016/S0140-6736(05)74233-1.CrossRefPubMed
32.
Lawn JE, Kerber K, Enweronu-Laryea C, Cousens S: 3.6 million neonatal deaths--what is progressing and what is not?. Semin Perinatol. 2010, 34 (6): 371-386. 10.1053/j.semperi.2010.09.011.CrossRefPubMed
33.
Moxon Sarah, Lawn Joy, Dickson Kim, Simen-Kapeu Aline, Gupta Gagan, Deorari Ashok, Singhal Nalini, New Karen, Kenner Carole, Bhutani Vinod, Kumar Rakesh, Molyneux Elizabeth, Blencowe Hannah: Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth. 2015, 15 (Suppl 2): S7-CrossRefPubMedPubMedCentral
34.
Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, et al: Achieving child survival goals: potential contribution of community health workers. Lancet. 2007, 369 (9579): 2121-2131. 10.1016/S0140-6736(07)60325-0.CrossRefPubMed
35.
Khanal S, Sharma J, Gc VS, Dawson P, Houston R, Khadka N, Yengden B: Community health workers can identify and manage possible infections in neonates and young infants: MINI--a model from Nepal. J Health Popul Nutr. 2011, 29 (3): 255-264.CrossRefPubMedPubMedCentral
36.
de Sousa A, Tiedje KE, Recht J, Bjelic I, Hamer DH: Community case management of childhood illnesses: policy and implementation in Countdown to 2015 countries. Bull World Health Organ. 2012, 90 (3): 183-190. 10.2471/BLT.11.093989.CrossRefPubMed
37.
Mohan P, Kishore B, Singh S, Bahl R, Puri A, Kumar R: Assessment of implementation of integrated management of neonatal and childhood illness in India. J Health Popul Nutr. 2011, 29 (6): 629-638.PubMedPubMedCentral
38.
WHO: Integrated management of childhood illness: Chart Booklet. 2014, Geneva: World Health Organization
39.
Mittal K, Gupta V, Khanna P, Kaushik JS, Sharma A: Evaluation of Integrated Management of Neonatal and Childhood Illness (IMNCI) algorithm for diagnosis and referral in under-five children. Indian J Pediatr. 2014, 81 (8): 797-799. 10.1007/s12098-013-1225-2.CrossRefPubMed
40.
41.
Afnan-Holmes H, Magoma M, John T, Levira F, Msemo G, Armstrong CE, et al: Tanzania's Countdown to 2015: analysis of two decades of progress and gaps for reproductive, maternal, newborn and child health, to inform post-2015 priorities. Lancet Global Health. 2015, 3 (7): e396-e409. 10.1016/S2214-109X(15)00059-5.CrossRefPubMed
42.
Irimu GW, Greene A, Gathara D, Kihara H, Maina C, Mbori-Ngacha D, et al: Explaining the uptake of paediatric guidelines in a Kenyan tertiary hospital--mixed methods research. BMC Health Serv Res. 2014, 14: 119-10.1186/1472-6963-14-119.CrossRefPubMedPubMedCentral
43.
Jacob ST, Lim M, Banura P, Bhagwanjee S, Bion J, Cheng AC, et al: Integrating sepsis management recommendations into clinical care guidelines for district hospitals in resource-limited settings: the necessity to augment new guidelines with future research. BMC medicine. 2013, 11: 107-10.1186/1741-7015-11-107.CrossRefPubMedPubMedCentral
44.
Baelani I, Jochberger S, Laimer T, Rex C, Baker T, Wilson IH, et al: Identifying resource needs for sepsis care and guideline implementation in the Democratic Republic of the Congo: a cluster survey of 66 hospitals in four eastern provinces. Middle East J Anaesthesiol. 2012, 21 (4): 559-575.PubMed
45.
Rasanathan K, Muniz M, Bakshi S, Kumar M, Solano A, Kariuki W, et al: Community case management of childhood illness in sub-Saharan Africa - findings from a cross-sectional survey on policy and implementation. Journal of global health. 2014, 4 (2): 020401-PubMedPubMedCentral
46.
Musiime GM, Seale AC, Moxon SG, Lawn JE: Risk of gentamicin toxicity in neonates treated for possible severe bacterial infection in low and middle income countries (IN PRESS). 2015
47.
Moxon Sarah, Ruysen Harriet, Kerber Kate, Amouzou Agbessi, Fournier Suzanne, Grove John, Moran Allisyn, Vaz Lara, Blencowe Hannah, Conroy Niall, Gülmezoglu Metin A, Vogel Joshua, Rawlins Barbara, Sayed Rubayet, Hill Kathleen, Vivio Donna, Qazi Shamim, Sitrin Deborah, Seale Anna, Wall Steve, Jacobs Troy, Ruiz Peláez Gabriel Juan, Guenther Tanya, Coffey Patricia, Dawson Penny, Marchant Tanya, Waiswa Peter, Deorari Ashok, Enweronu-Laryea Christabel, Arifeen El Shams, Lee Anne, Mathai Matthews, Lawn Joy: Count every newborn; a measurement improvement roadmap for coverage data. BMC Pregnancy Childbirth. 2015, 15 (S2): S8-CrossRefPubMedPubMedCentral
48.
Kissoon N, Burns J: Who should get pediatric intensive care when not all can? A call for international guidelines on allocation of pediatric intensive care resources*. Pediatr Crit Care Med. 2014, 15 (1): 82-83. 10.1097/PCC.0000000000000038.CrossRefPubMed
49.
Braun R, Catalani C, Wimbush J, Israelski D: Community health workers and mobile technology: a systematic review of the literature. PloS one. 2013, 8 (6): e65772-10.1371/journal.pone.0065772.CrossRefPubMedPubMedCentral
50.
Hazel E, Requejo J, David J, Bryce J: Measuring coverage in MNCH: evaluation of community-based treatment of childhood illnesses through household surveys. PLoS medicine. 2013, 10 (5): e1001384-10.1371/journal.pmed.1001384.CrossRefPubMedPubMedCentral
51.
Bhutta ZA, Zaidi AK, Thaver D, Humayun Q, Ali S, Darmstadt GL: Management of newborn infections in primary care settings: a review of the evidence and implications for policy?. Pediatr Infect Dis J. 2009, 28 (1 Suppl): S22-30.CrossRefPubMed
52.
Kerber Kate, Mathai Matthews, Lewis Gwyneth, Flenady Vicki, HM Erwich Jaap Jan, Segun Tunde, Aliganyira Patrick, Abdelmegeid Ali, Allanson Emma, Roos Nathalie, Rhoda Natasha, Lawn Joy, Pattinson Robert: Counting every stillbirth and neonatal death to improve quality of care for every pregnant woman and her baby. BMC Pregnancy Childbirth. 2015, 15 (S2): S9-CrossRefPubMedPubMedCentral
53.
Campbell H, El Arifeen S, Hazir T, O'Kelly J, Bryce J, Rudan I, Qazi SA: Measuring coverage in MNCH: challenges in monitoring the proportion of young children with pneumonia who receive antibiotic treatment. PLoS medicine. 2013, 10 (5): e1001421-10.1371/journal.pmed.1001421.CrossRefPubMedPubMedCentral
54.
WHO: Pocket book of hospital care for children: Guidelines of the management of common childhood illnesses. 2013, Geneva: World Health Organization
55.
Zaidi AK, Baqui AH, Qazi SA, Bahl R, Saha S, Ayede AI, et al: Scientific rationale for study design of community-based simplified antibiotic therapy trials in newborns and young infants with clinically diagnosed severe infections or fast breathing in South Asia and sub-Saharan Africa. Pediatr Infect Dis J. 2013, 32 (9 Suppl 1): S7-11.CrossRefPubMedPubMedCentral
56.
Esamai F, Tshefu AK, Ayede AI, Adejuyigbe EA, Wammanda RD, Baqui AH, et al: Ongoing trials of simplified antibiotic regimens for the treatment of serious infections in young infants in South Asia and sub-Saharan Africa: implications for policy. Pediatr Infect Dis J. 2013, 32 (9 Suppl 1): S46-49.CrossRefPubMedPubMedCentral
Metadata
Title
Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions
Authors
Aline Simen-Kapeu
Anna C Seale
Steve Wall
Christabel Nyange
Shamim A Qazi
Sarah G Moxon
Mark Young
Grace Liu
Gary L Darmstadt
Kim E Dickson
Joy E Lawn
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue Special Issue 2/2015
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-15-S2-S6

Other articles of this Special Issue 2/2015

BMC Pregnancy and Childbirth 2/2015 Go to the issue

Research

Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions

Research

Inpatient care of small and sick newborns: a multi-country analysis of health system bottlenecks and potential solutions

Research

Count every newborn; a measurement improvement roadmap for coverage data

Research

Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions

Research

Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions

Research

Antenatal corticosteroids for management of preterm birth: a multi-country analysis of health system bottlenecks and potential solutions