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Analysis Innovating for Neglected Diseases in South Asia

Neonatal sepsis in South Asia: huge burden and spiralling antimicrobial resistance

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k5314 (Published 22 January 2019) Cite this as: BMJ 2019;364:k5314
  1. Suman Chaurasia, consultant1,
  2. Sindhu Sivanandan, former senior resident1,
  3. Ramesh Agarwal, professor1,
  4. Sally Ellis, neonatal sepsis project leader2,
  5. Mike Sharland, professor3,
  6. M Jeeva Sankar, assistant professor1
  1. 1Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
  2. 2Global Antibiotic R&D Partnership, Drugs for Neglected Diseases initiative, Geneva, Switzerland
  3. 3Paediatric Infectious Diseases Research Group, St George’s University London, UK
  1. Correspondence to: M J Sankar jeevasankar{at}gmail.com

M Jeeva Sankar and colleagues call for urgent action to improve quality of care at birth and implement antimicrobial stewardship in health facilities in South Asia to reduce neonatal deaths from sepsis

Neonatal sepsis, a systemic infection in the first 28 days of life, encompasses bloodstream infections, meningitis, and pneumonia. It is the third most common cause of deaths among neonates, accounting for 225 000 deaths globally every year.1

South Asia and sub-Saharan Africa have the highest burden of neonatal sepsis in the world. Of the total sepsis related neonatal deaths in 2013, 38.9% occurred in South Asia.12 Poverty, low coverage of effective interventions, including facility births, and gross inequities in delivery of healthcare3 contribute to this situation. We review the available literature (box 1) to draw attention to the burden of neonatal sepsis, the pathogen profile, and the extent of antimicrobial resistance in South Asia, and propose priority actions for policymakers and health professionals in the region.

Box 1

Sources and methods

We searched PubMed and Web of Science for literature published between January 2000 and August 2018 using the search terms: (newborn OR neonate) AND (sepsis OR infection OR antibiotic OR antimicrobial). The results were filtered for South Asian countries. Bibliographies of full text articles and published systematic reviews were also searched to identify additional articles.

We identified 2699 and 220 articles from PubMed and Web of Science, respectively, and 19 additional articles from reference lists of identified articles. After removing duplicates, we screened 2768 articles and reviewed 223 full text articles. Finally, 109 studies were included: 69 from India, 16 from Pakistan, 7 from Bangladesh, 14 from Nepal, 1 from Sri Lanka, and 2 multi-country studies (Young Infant Study4 and Aetiology of Neonatal Infections in South Asia (ANISA)5) covering Bangladesh, India, and Pakistan). Because the datasets belonging …

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