How to close the maternal and neonatal sepsis gap in sub-Saharan Africa

Otu, Akaninyene; Nsutebu, Emmanuel; Hirst, Jane E; Thompson, Kelly; Walker, Karen; Yaya, Sanni

doi:10.1136/bmjgh-2020-002348

Cited by 14 publications

(18 citation statements)

References 52 publications

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“…In a paper from 2020 on neonatal mortality, the authors conclude that there is a need to develop clinical guidelines for prevention and management of neonatal sepsis that are specific to the Sub-Saharan African context. 10 Multiple studies aiming to identify the risk factors for neonatal sepsis have been performed in Sub-Saharan Africa during the last 10 years. With this systematic review and meta-analysis, we aim to provide quality evidence to identify the risk factors for neonatal sepsis in Sub-Saharan Africa.…”

Section: Open Accessmentioning

confidence: 99%

Risk factors for neonatal sepsis in Sub-Saharan Africa: a systematic review with meta-analysis

et al. 2022

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ObjectivesTo identify the risk factors for neonatal sepsis in Sub-Saharan Africa.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, Web of Science, African Index Medicus and ClinicalTrials.gov were searched for observational studies from January 2010 to August 2020.SettingSub-Saharan Africa, at all levels of healthcare facilities.Participants‘Neonates’ (<28 days of age) at risk of developing either clinical and/or laboratory-dependent diagnosis of sepsis.Outcome measuresIdentification of any risk factors for neonatal sepsis.ResultsA total of 36 studies with 23 605 patients from secondary or tertiary level of care facilities in 10 countries were included. Six studies were rated as good quality, 8 as fair and 22 as poor. Four studies were omitted in the meta-analysis due to insufficient data. The significant risk factors were resuscitation (OR 2.70, 95% CI 1.36 to 5.35), low birth weight <1.5 kg (OR 3.37, 95% CI 1.59 to 7.13) and 1.5–2.5 kg (OR 1.36, 95% CI 1.01 to 1.83), low Apgar score at the first minute (OR 3.69, 95% CI 2.34 to 5.81) and fifth minute (OR 2.55, 95% CI 1.46 to 4.45), prematurity <37 weeks (OR 1.91, 95% CI 1.27 to 2.86), no crying at birth (OR 3.49, 95% CI 1.42 to 8.55), male sex (OR 1.30, 95% CI 1.01 to 1.67), prolonged labour (OR 1.57, 95% CI 1.08 to 2.27), premature rupture of membranes (OR 2.15, 95% CI 1.34 to 3.47), multiple digital vaginal examinations (OR 2.22, 95% CI 1.27 to 3.89), meconium-stained amniotic fluid (OR 2.72, 95% CI 1.58 to 4.69), intrapartum maternal fever (OR 2.28, 95% CI 1.18 to 4.39), foul-smelling vaginal discharge (OR 3.31, 95% CI 2.16 to 5.09) and low socioeconomic status (OR 1.93, 95% CI 1.11 to 3.35). We found considerable heterogeneity in the meta-analysis of 11 out of 15 identified risk factors.ConclusionMultiple risk factors for neonatal sepsis in Sub-Saharan Africa were identified. We revealed risk factors not listed by the WHO guidelines. The included studies overall had high risk of bias and high heterogeneity and thus, additional research of high quality is needed.PROSPERO registration numberCRD42020191067.

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Section: Open Accessmentioning

confidence: 99%

Risk factors for neonatal sepsis in Sub-Saharan Africa: a systematic review with meta-analysis

et al. 2022

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“…Strengthening infection prevention and control procedures and best practices during labour, child-birth and post-natal care is one of the areas that has been identi ed to improve the prevention and management of neonatal sepsis. 31 Although training workshops were said to be routinely organized by health care institutions, it was noted that not all health workers had the opportunity to attend the workshops as the majority will be on duty leaving senior staff members to attend. Investing in health workers, which includes providing training and education opportunities, has been recommended as a key action towards reducing death due to neonatal sepsis in Sub-Saharan Africa.…”

Section: Discussionmentioning

confidence: 99%

“…Investing in health workers, which includes providing training and education opportunities, has been recommended as a key action towards reducing death due to neonatal sepsis in Sub-Saharan Africa. 31 Not attending workshops by the health workers may contribute to an increase in neonatal sepsis as the workers on the ground may lack knowledge on current trends on new-born care and infection control. It is recommended that all health workers get a chance to attend in-service training more often to keep up with the current trends in neonatal care and infection control management.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and practices contributing to sepsis in neonates admitted at a Children’s Hospital in Zimbabwe

Mathela

Mapfumo

Mzingwane

2022

Preprint

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Background Neonatal sepsis is a public health issue that consistently emerges as one of the main causes of neonatal morbidity and mortality. The aim of this study was to determine the risk factors and practices contributing to neonatal sepsis among neonates admitted at a Children’s Hospital in Bulawayo Zimbabwe. Methods A cross sectional study was conducted at a children’s hospital in Bulawayo Zimbabwe between September and October 2018. A total of 98 mothers of sick new-borns admitted in the children’s hospital and 36 health workers were recruited for the study. The mothers’ demographic characteristics, antenatal history, birth circumstances, and new-born practices were used to predict factors associated with neonatal sepsis risk using odds ratios and regression logistics. Qualitative data from health providers were transcribed, coded, analyzed into themes and triangulated with the information from the questionnaire. Results There were 40 (40.8%) new-borns clinically confirmed to have neonatal sepsis. The majority of sepsis cases (60%) were amongst neonates with low birth weight. Poor hand hygiene, application of substances including cow dung and breast milk for cord care and using information from other sources other than health care workers were the variables found to be associated with neonatal sepsis. Being a young mother (15–20 years) and experiencing some pregnancy related problems before or during delivery were also found to be significantly associated with neonatal sepsis. Problems highlighted by health care workers included shortage of medical sundries in the children’s hospital, infection control training programs not being attended by all personnel and poor hand washing and hygiene practices due to inadequate facilities Conclusions There was high prevalence of clinically confirmed neonatal sepsis among neonates admitted with suspected sepsis. Neonatal sepsis was associated with a variety of factors which included neonatal factors such as low birth weight; maternal factors such as age of the mother, attendance of antenatal clinic and practices associated with hygiene and cord care. Health facility related factors that are linked to infection control such as provision of adequate hand hygiene facilities, medical sundries and disinfectants and adequate training may also be associated with neonatal sepsis

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“…Improving AMS programs and reducing mortality from maternal sepsis require a systems approach that is regularly reviewed. 40 Existing programs may be recommending antibiotics with widespread resistance, that are unavailable or too expensive. Alternatively, there could be a lack of current education for the healthcare workers, who may base care on outdated information.…”

Section: Tis and Staphylococcus Aureus)mentioning

confidence: 99%

A scoping review of maternal antibiotic prophylaxis in low‐ and middle‐income countries: Comparison to WHO recommendations for prevention and treatment of maternal peripartum infection

Jury

Thompson

Hirst

2021

Intl J Gynecology & Obste

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Background: Sepsis is a leading cause of maternal death. Antimicrobials save lives, but inappropriate overuse increases risk of antimicrobial resistance. Objective: A scoping review comparing peripartum prophylactic antimicrobial use in low-and middle-income countries (LMICs) with WHO recommendations for prevention and treatment of maternal peripartum infection. Search strategy: Medline, Embase, Global Health, LILACS and the WHO Library databases were searched. Selection criteria: Publications from LMICs since 2015 describing maternal prophlyactic antibiotics for group B streptococcus (GBS), preterm-prelabor rupture of membranes (PPROM), cesarean section, manual placental removal, and third/fourthdegree perineal tears.Data collection and analysis: Publications were screened, and duplicates were removed. A scoping review was conducted using PRISMA guidelines. Owing to study heterogeneity, a narrative synthesis was performed.Main results: Of 1886 studies, 27 studies from 13 countries involving 43 774 women met the eligibility criteria. Polymerase chain reaction screening for GBS is feasible, though limited financially. In PPROM, up to 42% of GBS isolates demonstrated erythromycin resistance. Evidence around cesarean section antimicrobial prophylaxis largely supports WHO recommendations; however, prolonged or multidrug regimens were reported. Conclusion:There is limited evidence to challenge current WHO recommendations to prevent peripartum infection in LMICs. However, implementation challenges exist.Given the emergence of antimicrobial resistance, research is needed to ensure that peripartum prophylactic antimicrobial choices remain effective.

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How to close the maternal and neonatal sepsis gap in sub-Saharan Africa

Cited by 14 publications

References 52 publications

Risk factors for neonatal sepsis in Sub-Saharan Africa: a systematic review with meta-analysis

Risk factors for neonatal sepsis in Sub-Saharan Africa: a systematic review with meta-analysis

Risk factors and practices contributing to sepsis in neonates admitted at a Children’s Hospital in Zimbabwe

A scoping review of maternal antibiotic prophylaxis in low‐ and middle‐income countries: Comparison to WHO recommendations for prevention and treatment of maternal peripartum infection

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