[5450A.2] Etiology of Community Acquired Neonatal Infections in Bangladesh

Samir K. Saha, Gary L. Darmstadt, Abdullah H. Baqui, Derrick Crook, Shams E.l. Arifeen, A.S.M. N. Ahmed, Maksuda Islam, Kaniz Fatima, M. H. Seraji, Ishtiaq Mannan, K. Z. Hasan, Sanwarul Barul, Saifuddin Ahmed, Syed M. Rahman, Mathuram Santosham, Robert E. Black, PROJAHNMO Study Group. Department of Microbiology, Dhaka Shishu Hospital, Bangladesh; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Save the Children-US, Washington, DC; Department of Paediatrics, Oxford University, United Kingdom; Child Health Division, Centre for Population Health Research, Dhaka, Bangladesh; Department of Paediatrics, Kumudini Medical College Hospital, Mirzapur, Bangladesh.

An estimated 36% of the 4 million annual neonatal deaths globally are due to serious infections, and 50-70% occur in the first week of life.

OBJECTIVE: We conducted prospective, population-based surveillance in a rural community of 146,000 in Mirzapur sub-district, Bangladesh, to determine the agents of neonatal infections.

DESIGN/METHODS: Community health workers each covered 4,000 population and provided antenatal health education in the home, including danger-sign recognition and care-seeking for newborn illness. They also visited the home on postnatal days 0, 3, 6 and 9 and used an algorithm adapted from IMCI to identify and refer sick newborns for tertiary-level care to Kumudini Hospital, where cultures were obtained for suspected sepsis.

Of 5,093 infants enrolled from February 2004 to September 2005, 20% (N=1043) were referred by CHWs or self-referred for suspected serious neonatal illness, 10% (N=496) were admitted, and 6% (N=312) had blood cultures drawn for suspected sepsis. A pathogen was isolated from 18 blood cultures (6% of cultures drawn), 8 (44%) in the early neonatal period (days 0-6) and 4 (22%) from the very early neonatal period (days 0-3). The most common isolates were S. aureus (N=9), K. pneumoniae (N=2) and P. aeruginosa (N=2). Skin infection was prominent in 4 (22%) of these neonates, and another had omphalitis.

CONCLUSIONS: Our population-based surveillance in rural Bangladesh showed that S. aureus was the major pathogen in cases of community-acquired sepsis. We are now investigating the viral etiology of suspected sepsis cases, and aim to identify previously undetected bacterial genome in preserved specimens, and to investigate whether the same organisms that causes skin infections also appeared in the blood of septic newborns.


Tuesday, May 2, 2006 10:30 AM

Platform Session: Neonatal Infectious Diseases in Developing Countries (10:15 AM - 12:15 PM)

Course Number: 5450A