Intended for healthcare professionals

Feature Perinatal infection

The scourge of avoidable neonatal mortality in Malawi

BMJ 2018; 362 doi: (Published 09 August 2018) Cite this as: BMJ 2018;362:k3434
  1. Madlen Davies, journalist
  1. Bureau of Investigative Journalism, London WC1X 8DP, UK
  1. madlendavies{at}

Sanitation is lacking, infection is common, only limited antibiotics are available, and microbial resistance is rising, writes Madlen Davies

The infants at Chatinkha nursery, the baby ward in Queen Elizabeth hospital in Blantyre, Malawi’s second city, are lined up in wooden cots, wrapped in brightly coloured fabric. Many have nasogastric tubes. Some are crying, others are listless. Kondwani Kawaza, Malawi’s first ever neonatologist, looks out over the ward. Many of the infants will die before the end of the month.

About 15 of the 200 babies admitted every month are diagnosed as having sepsis, but Kawaza says that this is the “tip of the iceberg.” He thinks that if they could diagnose it properly it would be the leading cause of death.

Survival decreases substantially for every hour that a patient with septic shock doesn’t receive effective antibiotics. Those that don’t die face brain damage, organ impairment, and lifelong behavioural problems.

“You have a mother who has waited for nine months to get a baby,” says Kawaza, “And then you lose that baby to a potentially treatable condition.”

Resistance to stocked antibiotics

Throughout Malawi healthcare facilities are struggling to reduce the number of babies dying from preventable causes like sepsis. Queen Elizabeth hospital now faces an extra threat: the bacteria that commonly cause bloodstream infections have developed resistance to all of the antibiotics it regularly stocks.

In the past, babies mainly had infections of Group B streptococcus or Streptococcus pneumoniae, Kawaza explains. But these have largely disappeared through vaccinating babies or screening high risk mothers. In their wake, infections of the gram negative bacteria commonly found in the gut have risen, mainly Klebsiella and Escherichia coli. Traditionally, these were hospital acquired infections in people who had been in intensive care for a long …

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