Experiences with Neonatal Infectous Disease in Low-Income Countries: Caribbean Nations
Upton D. Allen of The Hospital for Sick Children and the University of Toronto, Toronto, Canada, discussed the problem of neonatal infectious diseases in the Caribbean region (Figure 8.1)
The situation in the Caribbean countries is similar to that of many other countries with neonatal infectious diseases responsible for 30-40 per cent of the high neonatal mortality rate. In addition, he addressed the spectrum of organisms seen (non-viral), notably in nosocomial infections, antimicrobial resistance and research priorities.
Dr. Allen discussed the results of two studies – one from Trinidad and one from Jamaica (Figures 8.2 and 8.3). The definition of infection in the Jamaican study is shown in Figure 8.4. The incidence of neonatal infections in Caribbean countries varied from 3-10.3/1000 live births (Figure 8.5). In Jamaica gram-negative organisms were predominant (Figure 8.6) although coagulase negative staphylococcus was also a significant cause of infection (Figure 8.7).
In both Trinidad and Jamaica outbreaks of infections in the neonatal nurseries occurred, all of them due to gram negative organisms (Figure 8.8). The causes of these outbreaks were related, at least in part, to problems in care within the hospitals (Figure 8.9).
Antibiotic resistance was prevalent, as shown in Figure 8.10. This makes the management of these infections particularly difficult in some settings.
Dr. Allen also highlighted the problem of neonatal fungal infections, which are often difficult to diagnose ante-mortem. He indicated the need for certain research priorities to be addressed in regions such as the Caribbean including, but not limited to, the following:
- Need for enhanced research support infrastructure
- Data on the epidemiology and risk factors associated with sepsis
- Antimicrobial resistance trends
- Evaluation of infection prevention and control strategies
- Diagnostic strategies in resource-poor settings
- Cost-effectiveness of specific interventions (e.g. GBS screening)
- Evaluation of effectiveness, safety and acceptability of simplified parenteral treatment strategies