TY - JOUR
T1 - Incidence and risk factors of neonatal infections in a rural Bangladeshi population
T2 - A community-based prospective study
AU - Mitra, Dipak K.
AU - Mullany, Luke C.
AU - Harrison, Meagan
AU - Mannan, Ishtiaq
AU - Shah, Rashed
AU - Begum, Nazma
AU - Moin, Mamun Ibne
AU - El Arifeen, Shams
AU - Baqui, Abdullah H.
N1 - Funding Information:
Funding for the parent chlorhexidine trial was provided by the United States Agency for International Development, Office of Health, Infectious Diseases, and Nutrition; Global Health Bureau and the Dhaka Mission through the Global Research Activity Cooperative Agreement (GHS-A-00-03-00019-00); and the Saving Newborn Lives initiative of Save the Children Federation-USA through a grant from the Bill and Melinda Gates Foundation. Dipak K. Mitra was supported through Fogarty Training Grant (Grant # D43TW7587) during the period of the data analyses and manuscript writing. The funders of the study had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.
Funding Information:
The study was conducted by the Projahnmo study group in Bangladesh. Projhanmo is a partnership of the International Centre for Diarrheal Disease Research, Bangladesh; the Bangladesh government’s Ministry of Health and Family Welfare; Shimantik (a Bangladeshi non-governmental organization); Save the Children-US; Dhaka Shishu Hospital; and the Johns Hopkins Bloomberg School of Public Health, USA. We especially thank the members of the Projahnmo study team and colleagues at the Bangladesh Ministry of Health and Family Welfare at the sub-district, district, and central levels for their valuable help and advice. We thank the many individuals in Sylhet District who gave their time generously as well as the Projahnmo field and data management staff who worked tirelessly on this study. Finally, we thank the Sylhet communities who hosted this study and especially the study participants for their participation in this study.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/3/9
Y1 - 2018/3/9
N2 - Background: Infections cause about one fifth of the estimated 2.7 million annual neonatal deaths worldwide. Population-based data on burden and risk factors of neonatal infections are lacking in developing countries, which are required for the appropriate design of effective preventive and therapeutic interventions in resource-poor settings. Methods: We used data from a community-based cluster-randomized trial conducted to evaluate the impact of two umbilical cord cleansing regimens with chlorhexidine solution on neonatal mortality and morbidity in a rural area of Sylhet District in Bangladesh. Newborns were assessed four times in the first 9 days of life by trained community health workers (CHWs) using a WHO IMCI-like clinical algorithm. Cumulative incidence of the first episode of infections in the first 9 days of life was estimated using survival analysis technique accounting for survival bias and competing risk of death before the occurrence of infection. A multivariable generalized estimating equation log-binomial regression model was used to identify factors independently associated with infections. Results: Between 2007 and 2009, 30,267 newborns who received at least one postnatal assessment visit by a CHW within the first 9 days of life were included in this study. Cumulative incidence of infections in the first 9 days of life was 14.5% (95% CI 14.1-14.9%). Significant risk factors included previous child death in the family [RR 1.10 (95% CI 1.02-1.19)]; overcrowding [RR 1.14 (95% CI 1.04-1.25)]; home delivery [RR 1.86 (95% CI 1.58-2.19)]; unclean cord care [RR 1.15 (95% CI 1.03-1.28)]; multiple births [RR 1.34 (95% CI 1.15-1.56)]; low birth weight [reference: ≥ 2500 g, RR (95% CI) for < 1500, 1500-1999, and 2000-2499 g were 4.69 (4.01-5.48), 2.15 (1.92-2.42), and 1.15 (1.07-1.25) respectively]; and birth asphyxia [RR 1.65 (1.51-1.81)]. Higher pregnancy order lowered the risk of infections in the study population [compared to first pregnancy, RR (95% CI) for second, third, and ≥ fourth pregnancy babies were 0.93 (0.85-1.02), 0.88 (0.79-0.97), and 0.79 (0.71-0.87), respectively]. Conclusion: Neonatal infections and associated deaths can be reduced by identifying and following up high-risk mothers and newborns and promoting facility delivery and clean cord care in resource-poor countries like Bangladesh where the burden of clinically ascertained neonatal infections is high. Further research is needed to measure the burden of infections in the entire neonatal period, particularly in the second fortnight and its association with essential newborn care. Trial registration: NCT00434408. Registered February 9, 2007.
AB - Background: Infections cause about one fifth of the estimated 2.7 million annual neonatal deaths worldwide. Population-based data on burden and risk factors of neonatal infections are lacking in developing countries, which are required for the appropriate design of effective preventive and therapeutic interventions in resource-poor settings. Methods: We used data from a community-based cluster-randomized trial conducted to evaluate the impact of two umbilical cord cleansing regimens with chlorhexidine solution on neonatal mortality and morbidity in a rural area of Sylhet District in Bangladesh. Newborns were assessed four times in the first 9 days of life by trained community health workers (CHWs) using a WHO IMCI-like clinical algorithm. Cumulative incidence of the first episode of infections in the first 9 days of life was estimated using survival analysis technique accounting for survival bias and competing risk of death before the occurrence of infection. A multivariable generalized estimating equation log-binomial regression model was used to identify factors independently associated with infections. Results: Between 2007 and 2009, 30,267 newborns who received at least one postnatal assessment visit by a CHW within the first 9 days of life were included in this study. Cumulative incidence of infections in the first 9 days of life was 14.5% (95% CI 14.1-14.9%). Significant risk factors included previous child death in the family [RR 1.10 (95% CI 1.02-1.19)]; overcrowding [RR 1.14 (95% CI 1.04-1.25)]; home delivery [RR 1.86 (95% CI 1.58-2.19)]; unclean cord care [RR 1.15 (95% CI 1.03-1.28)]; multiple births [RR 1.34 (95% CI 1.15-1.56)]; low birth weight [reference: ≥ 2500 g, RR (95% CI) for < 1500, 1500-1999, and 2000-2499 g were 4.69 (4.01-5.48), 2.15 (1.92-2.42), and 1.15 (1.07-1.25) respectively]; and birth asphyxia [RR 1.65 (1.51-1.81)]. Higher pregnancy order lowered the risk of infections in the study population [compared to first pregnancy, RR (95% CI) for second, third, and ≥ fourth pregnancy babies were 0.93 (0.85-1.02), 0.88 (0.79-0.97), and 0.79 (0.71-0.87), respectively]. Conclusion: Neonatal infections and associated deaths can be reduced by identifying and following up high-risk mothers and newborns and promoting facility delivery and clean cord care in resource-poor countries like Bangladesh where the burden of clinically ascertained neonatal infections is high. Further research is needed to measure the burden of infections in the entire neonatal period, particularly in the second fortnight and its association with essential newborn care. Trial registration: NCT00434408. Registered February 9, 2007.
KW - Bangladesh
KW - Neonatal infections
KW - Prospective study
KW - Risk factors
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U2 - 10.1186/s41043-018-0136-2
DO - 10.1186/s41043-018-0136-2
M3 - Article
C2 - 29523194
AN - SCOPUS:85067175361
SN - 1606-0997
VL - 37
JO - Journal of Health, Population and Nutrition
JF - Journal of Health, Population and Nutrition
IS - 1
M1 - 6
ER -