Despite international efforts to prevent deaths among children under the age of five, newborn mortality rates continue to be high.
According to UNICEF, with an estimated 6,700 newborn deaths per day, newborn infants made up nearly half of all young child fatalities in 2019.
Infections were a prominent factor in the deaths that occurred in sub-Saharan Africa, where 42 percent of deaths occurred.
A six-year study was conducted by the Baby GERMS-SA team, which was led by specialists from the National Institute for Communicable Diseases, a branch of the National Health Laboratory Service, to determine the prevalence of meningitis and culture-confirmed neonatal bloodstream infections in South Africa.
The study, which was supported by the Bill & Melinda Gates Foundation, examined the blood and cerebrospinal fluid culture pathology records of newborn infants at 256 public hospitals.
The study found that a significant number of infections were brought on by bacteria that were multi-drug resistant and that the majority of infections occurred after day 3 of life.
As a result, they were likely acquired in hospitals.
This study, which examined invasive newborn infections at the national population level for the first time in the local public health sector, included infants younger than 28 days who were admitted between January 2014 and December 2019.
Over the course of the six-year period, close to 38 000 infection cases were identified.
At the time of infection diagnosis, newborns were typically 7 days old.
Three bacterial pathogens—Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus—were responsible for over 70% of cases.
None of these pathogens are vaccine-preventable, and several of them were resistant to the antibiotics typically used to treat newborn infections.
Hospitals in the provinces of Gauteng and KwaZulu-Natal diagnosed two-thirds of the cases.
The national annual incidence risk, which measures the number of new cases of invasive newborn infections as a percentage of annually recorded live births, increased over the course of the study period.
Regional hospitals provided the diagnosis in over 50 percent of newborn infection cases.
The incidence risk of late-onset infections—likely acquired in hospitals—was significantly greater than that reported in nations with abundant resources.
The work fills a critical knowledge gap, and these burden estimates will operate as a benchmark for evaluating the effectiveness of future interventions in South Africa.
Additionally, the study’s authors note that antimicrobial stewardship programs in newborn facilities need to be reinforced along with infection prevention and control strategies.
Finally, it is emphasized how critical it is to allocate funds wisely across the many public sector health facilities.