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Background Survivors of invasive Group B streptococcus (iGBS) disease, notably meningitis, are at increased risk of neurodevelopment impairment (NDI). However, the limited studies to date have a median follow-up to 18 months and mainly focused on moderate/severe NDI, with no previous studies on emotional-behavioural problems among iGBS survivors. Methods In this multi-country, matched cohort study, we included children aged 18 months to 17 years with infant iGBS sepsis and meningitis from health demographic surveillance systems, or hospital records in Argentina, India, Kenya, Mozambique and South Africa. Children without iGBS history were matched to iGBS survivors on sex and age. Our primary outcomes were emotional-behavioural problems and psychopathologies as measured with the Child Behaviour Checklist (CBCL). The CBCL was completed by the child’s primary caregiver. Results Between October 2019 and April 2021, 573 children (mean age of 7.18 years old) were assessed: 156 iGBS survivors and 417 non-iGBS comparison children. On average, we observed more total problems and more anxiety, attention and conduct problems for school-aged iGBS survivors compared with the non-iGBS group. No differences were found in the proportion of DSM-5 defined, clinically significant psychopathologies. Conclusions Our findings suggested that school age iGBS survivors experienced increased mild emotional behavioural problems which may impact children and families. At-risk neonates including iGBS survivors need long-term follow-up with integrated emotional-behavioural assessments and appropriate care. Scale-up will require simplified assessments that are free and culturally adapted.

Background Invasive Group B Streptococcus (iGBS) sepsis and meningitis are important causes of child mortality, but studies on neurodevelopmental impairment (NDI) after iGBS are limited. Using Griffiths Mental Development Scales-Extended Revised (GMDS-ER), we described NDI in iGBS survivors and non-iGBS children from South Africa, as part of a five-country study. Methods We identified children aged 5 -8 years with a history of iGBS and children with no history of iGBS between October 2019 - January 2021. Children were matched on sex, and birth data (month, year) (matched cohort study). Moderate-severe NDI was the primary outcome as a composite of GMDS-ER motor, GMDS-ER cognition, hearing and vision. Secondary outcomes included mild NDI, any emotional-behavioural problems, and GMDS-ER developmental quotients (DQ) calculated by dividing the age equivalent GMDS-ER score by the chronological age. Results 160 children (iGBS survivors, 43; non-iGBS, 117) were assessed. Amongst iGBS survivors 13 (30.2%) had meningitis and 30 (69.8%) had sepsis. Six (13.9%) iGBS survivors, and five (4.3%) non-iGBS children had moderate-severe NDI. iGBS exposure was associated with a 5.56 (95%CI: 1.07-28.93; p=0.041) adjusted odds of moderate-severe NDI at 5-8 years. Compared to the non-iGBS children, iGBS meningitis survivors had a significantly lower global median DQ (p < 0.05), as well as a lower median DQ for the language and performance GMDS-ER subscale (p<0.05). Conclusions Children surviving iGBS, particularly meningitis, are more likely to have NDI at 5 - 8 years compared to non-iGBS children. Further research is required to improve detection and care for at-risk newborns.

Background Sepsis and meningitis are amongst the leading causes of neonatal deaths in Sub-Saharan Africa (SSA). Neonatal sepsis caused around 400000 deaths globally in 2015, half occurring in Africa. Despite this, there are few published data on the acute costs of neonatal sepsis or meningitis, particularly in low- and middle-income countries, and none in SSA. Methods We collected data on neonates admitted to two hospitals between April 16, 2020 and April 1, 2021. In South Africa cases were microbiologically confirmed either by culture or PCR. In Mozambique clinically suspected and microbiologically confirmed cases were included. Data were collected on healthcare resource use and length-of-stay. A caregivers questionnaire gathered data on expenditure and caregiving. We used unit costs of healthcare resources in local currencies to estimate average healthcare provider cost per patient and average costs per household. Results were converted to 2019 international dollars (I$). Results We enrolled 11 neonates in Mozambique, 18 neonates in South Africa. Mean length-of-stay was 10 days (median=9; IQR=4-14)) and 16 days (median=15; IQR=13-18). In Mozambique we estimated mean household costs of I$49.62 (median=10.19, IQR=5.10-95.12) and hospitalisation costs of I$307.58 (median=275.12; IQR=149.43-386.12). In South Africa these costs were I$52.31 (median=30.82; IQR=19.25-73.08) and I$684.06 (median=653.62; IQR=543.33-827.53), respectively. On average, parents in Mozambique spent an extra 52 hours (median=38.5; IQR=19-86) on caregiving, and in South Africa an extra 76 (median=3.5; IQR=0-120). Conclusion We found substantial costs associated with acute neonatal bacterial (all-cause) sepsis and meningitis in SSA. Our estimates will inform cost-effectiveness analyses of interventions to prevent invasive bacterial infections in neonates.