Imagine you are the mother of a newborn baby. One day you notice your baby is not feeding well and is less alert than usual. You want to seek medical care, but you live in a rural village — an expensive six-hour journey away from the closest hospital. Even if you managed to find transport, you worry your baby might not survive the long journey. As your baby gets weaker, you feel more helpless.
This heartbreaking scenario is reality for hundreds of thousands of mothers and babies worldwide, particularly in sub-Saharan Africa and South Asia. Serious infections, such as meningitis, sepsis, and pneumonia kill over 700,000 newborns every year. These infections are difficult to detect in small babies, so when newborns show signs of possible serious infection, they require urgent evaluation and treatment. In developing countries, this can be approximately 10 percent of all newborns.
If you live in the United States or other industrialized countries, your newborn will be admitted to the hospital and started on antibiotics given through an IV or injection. Doctors and nurses will monitor his progress carefully. The chance of your baby surviving is more than 99 percent.
But if you are poor and live in sub-Saharan Africa or South Asia, you may not have access to hospital care due to distance, cost or other cultural and family obligations. If you manage to make it to a hospital, there might not be enough medication, space, or qualified staff to take care of your newborn. You might then seek care from a traditional village doctor, only to receive ineffective treatment for your newborn’s illness. The chance of your baby surviving is about 60 percent if you make it to the hospital — and even less for those that don’t.
How do we begin to fix this problem?
Earlier this month, the World Health Organization released groundbreaking guidelines, based on rigorous research trials published in The Lancet. The studies found that newborns with possible serious bacterial infection, whose caregivers could not accept hospital referral, could be safely treated with a combination of oral and injectable antibiotics closer to home, as an outpatient. Although hospital care remains the standard of care, we now have a safe, effective alternative for when a trip to the hospital is not possible, helping us reach large numbers of newborns who would otherwise not have access to treatment.
As a mother, I feel a sense of relief for all the families with poor access to hospitals seeking care for their sick newborns.
As a pediatrician, I am reassured that these guidelines, which offer a truly groundbreaking option for management of possible serious bacterial infection in newborns when hospitalization is not possible, are based on rigorous research and have been vetted by an international body of technical experts at the WHO.
And as a public health professional, I feel a sense of urgency to bridge our advancements in public health with our medical professional associations, ministries of health, aid agencies, and nongovernmental organizations. They need to know this option exists and we need to work together to make this effective solution more widely available.
Finding the pathway to effective coverage will not be easy. Lack of nuanced understanding by health professionals and planners of the simplified regimens remains a major obstacle. Several implementation research trials now underway will help us better understand how to implement the new regimens effectively at scale, including necessary human resources and monitoring requirements. At the same time, we will need to continue to strengthen hospitals and health care workforces in developing countries so that hospital-based management of possible serious newborn infection, which remains the standard of care, can become a reality for all.
This September, world leaders endorsed the Sustainable Development Goals at the United Nations General Assembly meeting in New York. One of the new targets is to end preventable deaths of newborns and children under age 5 by 2030. Most deaths from newborn infections are preventable, and these guidelines, if adopted and effectively implemented, could save the lives of hundreds of thousands of newborns every year.
Dr. Bina Valsangkar is a newborn technical adviser for the Saving Newborn Lives program at Save the Children. She works with health ministries and other partners in Malawi, Uganda, and Ethiopia to reduce neonatal mortality. Valsangkar completed her pediatrics residency at Children’s National Medical Center in Washington, D.C., medical school at the University of Michigan, and a master’s in public health from Harvard University. She is adjunct assistant professor of pediatrics at George Washington University.
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