Treatment of Infections in Young Infants in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis of Frontline Health Worker Diagnosis and Antibiotic Access

Anne C C Lee, Aruna Chandran, Hadley K. Herbert, Naoko Kozuki, Perry Markell, Rashed Shah, Harry Campbell, Igor Rudan, Abdullah Baqui

Research output: Contribution to journalArticle

Abstract

Background: Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (

Methods and Findings: We searched PubMed, Embase, WHO/Health Action International (HAI), databases, service provision assessments (SPAs), Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and grey literature with no date restriction until May 2014. Data were identified from 37 published studies, 46 HAI national surveys, and eight SPAs. For study question 1, meta-analysis showed that clinical sign-based algorithms predicted bacterial infection in young infants with high sensitivity (87%, 95% CI 82%–91%) and lower specificity (62%, 95% CI 48%–75%) (six studies, n = 14,254). Frontline health workers diagnosed pBI in young infants with an average sensitivity of 82% (95% CI 76%–88%) and specificity of 69% (95% CI 54%–83%) (eight studies, n = 11,857) compared to physicians. For question 2, first-line injectable agents (ampicillin, gentamicin, and penicillin) had low variable availability in first-level health facilities in Africa and South Asia. Oral amoxicillin and cotrimoxazole were widely available at low cost in most regions. For question 3, no studies on young infants were identified, however 25% of pediatric antibiotic purchases in LMICs were obtained without a prescription (11 studies, 95% CI 18%–34%), with lower rates among infants

Conclusions: Trained frontline health workers may screen for pBI in young infants with relatively high sensitivity and lower specificity. Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia. Improved data and advocacy are needed to increase the availability and appropriate utilization of antibiotics for young infant infections in LMICs.

Review Registration: PROSPERO International prospective register of systematic reviews (CRD42013004586).

Please see later in the article for the Editors' Summary.

Original languageEnglish (US)
JournalPLoS Medicine
Volume11
Issue number10
DOIs
StatePublished - 2014

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Meta-Analysis
Anti-Bacterial Agents
Health
Infection
Health Facilities
Therapeutics
Literature
Injections
Amoxicillin
Sulfamethoxazole Drug Combination Trimethoprim
Ampicillin
South Africa
Gentamicins
Bacterial Infections
PubMed
Penicillins
Health Status
Prescriptions
Demography
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Treatment of Infections in Young Infants in Low- and Middle-Income Countries : A Systematic Review and Meta-analysis of Frontline Health Worker Diagnosis and Antibiotic Access. / Lee, Anne C C; Chandran, Aruna; Herbert, Hadley K.; Kozuki, Naoko; Markell, Perry; Shah, Rashed; Campbell, Harry; Rudan, Igor; Baqui, Abdullah.

In: PLoS Medicine, Vol. 11, No. 10, 2014.

Research output: Contribution to journalArticle

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title = "Treatment of Infections in Young Infants in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis of Frontline Health Worker Diagnosis and Antibiotic Access",
abstract = "Background: Inadequate illness recognition and access to antibiotics contribute to high case fatality from infections in young infants (Methods and Findings: We searched PubMed, Embase, WHO/Health Action International (HAI), databases, service provision assessments (SPAs), Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and grey literature with no date restriction until May 2014. Data were identified from 37 published studies, 46 HAI national surveys, and eight SPAs. For study question 1, meta-analysis showed that clinical sign-based algorithms predicted bacterial infection in young infants with high sensitivity (87{\%}, 95{\%} CI 82{\%}–91{\%}) and lower specificity (62{\%}, 95{\%} CI 48{\%}–75{\%}) (six studies, n = 14,254). Frontline health workers diagnosed pBI in young infants with an average sensitivity of 82{\%} (95{\%} CI 76{\%}–88{\%}) and specificity of 69{\%} (95{\%} CI 54{\%}–83{\%}) (eight studies, n = 11,857) compared to physicians. For question 2, first-line injectable agents (ampicillin, gentamicin, and penicillin) had low variable availability in first-level health facilities in Africa and South Asia. Oral amoxicillin and cotrimoxazole were widely available at low cost in most regions. For question 3, no studies on young infants were identified, however 25{\%} of pediatric antibiotic purchases in LMICs were obtained without a prescription (11 studies, 95{\%} CI 18{\%}–34{\%}), with lower rates among infants Conclusions: Trained frontline health workers may screen for pBI in young infants with relatively high sensitivity and lower specificity. Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia. Improved data and advocacy are needed to increase the availability and appropriate utilization of antibiotics for young infant infections in LMICs.Review Registration: PROSPERO International prospective register of systematic reviews (CRD42013004586).Please see later in the article for the Editors' Summary.",
author = "Lee, {Anne C C} and Aruna Chandran and Herbert, {Hadley K.} and Naoko Kozuki and Perry Markell and Rashed Shah and Harry Campbell and Igor Rudan and Abdullah Baqui",
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