Prevalence of clinical signs of possible serious bacterial infection and mortality associated with them from population-based surveillance of young infants from birth to 2 months of age
Community-based data on the prevalence of clinical signs of possible serious bacterial infection (PSBI) and the mortality associated with them are scarce. The aim was to examine the prevalence for each sign of infection and mortality associated with infants in the first two months of life, using com...
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creator | Puri, Dhruv Nisar, Yasir Bin Tshefu, Antoinette Longombe, Adrien Lokangaka Esamai, Fabian Marete, Irene Ayede, Adejumoke Idowu Adejuyigbe, Ebunoluwa A Wammanda, Robinson D Qazi, Shamim Ahmad Bahl, Rajiv |
description | Community-based data on the prevalence of clinical signs of possible serious bacterial infection (PSBI) and the mortality associated with them are scarce. The aim was to examine the prevalence for each sign of infection and mortality associated with infants in the first two months of life, using community surveillance through community health workers (CHW).
We used population-based surveillance data of infants up to two months of age from the African Neonatal Sepsis Trial (AFRINEST). In this study, CHWs visited infants up to 10 times during the first two months of life at five sites in three sub-Saharan African countries. CHW assessed the infant for signs of infection (local or systemic) and referred infants who presented with any sign of infection to a health facility. We used a longitudinal analysis to calculate the risk of death associated with the presence of a sign of infection at the time of the visit until the subsequent visit.
During the first two months of their life, CHWs visited 84,759 live-born infants at least twice. In 11,089 infants (13.1%), one or more signs of infection were identified, of which 237 (2.1%) died. A sign of infection was detected at 2.1% of total visits. In 52% of visits, infants had one or more sign of systemic infection, while 25% had fast breathing in 7-59 days period and 23% had a local infection. All signs of infection, including multiple signs, were more frequently seen in the first week of life. The risk of mortality was very low (0.2%) for local infections and fast breathing in 7-59 days old, it was low for fast breathing 0-6 days old (0.6%), high body temperature (0.7%) and severe chest indrawing (1.0%), moderate for low body temperature (4.9%) and stopped feeding well/not able to feed at all (5.0%) and high for movement only when stimulated or no movement at all (10%) and multiple signs of systemic infection (15.5%). The risk of death associated with most clinical signs was higher (1.5 to 9 times) in the first week of life than at later age, except for low body temperature (4 times lower) as well as high body temperature (2 times lower).
Signs of infections are common in the first two months of life. The mortality risk differs with clinical signs and can be grouped as very low (local infections, fast breathing 7-59 days), low (fever, severe chest indrawing and fast breathing 0-6 days), moderate (low body temperature and stopped feeding well/not able to feed at all) and high (for movements only on stimulation or no |
doi_str_mv | 10.1371/journal.pone.0247457 |
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We used population-based surveillance data of infants up to two months of age from the African Neonatal Sepsis Trial (AFRINEST). In this study, CHWs visited infants up to 10 times during the first two months of life at five sites in three sub-Saharan African countries. CHW assessed the infant for signs of infection (local or systemic) and referred infants who presented with any sign of infection to a health facility. We used a longitudinal analysis to calculate the risk of death associated with the presence of a sign of infection at the time of the visit until the subsequent visit.
During the first two months of their life, CHWs visited 84,759 live-born infants at least twice. In 11,089 infants (13.1%), one or more signs of infection were identified, of which 237 (2.1%) died. A sign of infection was detected at 2.1% of total visits. In 52% of visits, infants had one or more sign of systemic infection, while 25% had fast breathing in 7-59 days period and 23% had a local infection. All signs of infection, including multiple signs, were more frequently seen in the first week of life. The risk of mortality was very low (0.2%) for local infections and fast breathing in 7-59 days old, it was low for fast breathing 0-6 days old (0.6%), high body temperature (0.7%) and severe chest indrawing (1.0%), moderate for low body temperature (4.9%) and stopped feeding well/not able to feed at all (5.0%) and high for movement only when stimulated or no movement at all (10%) and multiple signs of systemic infection (15.5%). The risk of death associated with most clinical signs was higher (1.5 to 9 times) in the first week of life than at later age, except for low body temperature (4 times lower) as well as high body temperature (2 times lower).
Signs of infections are common in the first two months of life. The mortality risk differs with clinical signs and can be grouped as very low (local infections, fast breathing 7-59 days), low (fever, severe chest indrawing and fast breathing 0-6 days), moderate (low body temperature and stopped feeding well/not able to feed at all) and high (for movements only on stimulation or no movements at all and multiple signs of infection). New treatment strategies that consider differential mortality risk could be developed and evaluated based on these findings.
The trial was registered with Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0247457</identifier><identifier>PMID: 33626090</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescents ; Age ; Aging ; Bacterial diseases ; Bacterial infections ; Biology and Life Sciences ; Body temperature ; Children ; Childrens health ; Data analysis ; Demographic aspects ; Diagnosis ; Direct reduction ; Editing ; Fatalities ; Fever ; Health risks ; Health surveillance ; Hospitals ; Infants ; Infections ; Medicine ; Medicine and Health Sciences ; Meta-analysis ; Methodology ; Mortality ; Mortality risk ; Neonates ; Newborn babies ; Patient outcomes ; Pediatrics ; People and Places ; Public health ; Sepsis ; Signs</subject><ispartof>PloS one, 2021-02, Vol.16 (2), p.e0247457-e0247457</ispartof><rights>COPYRIGHT 2021 Public Library of Science</rights><rights>2021 World Health Organization. License: http://creativecommons.org/licenses/by/3.0/igo/ (the “License”) e Public Library of Science. This is an open access article distributed under the Creative Commons Attribution IGO License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2021 World Health Organization. Licensee Public Library of Science 2021 World Health Organization. Licensee Public Library of Science</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-98a9975f6ad41e9639819313d1ff2db0bb2baea5666a129c8f80caf701129a053</citedby><cites>FETCH-LOGICAL-c692t-98a9975f6ad41e9639819313d1ff2db0bb2baea5666a129c8f80caf701129a053</cites><orcidid>0000-0002-9720-5699</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904202/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7904202/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33626090$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Marotta, Claudia</contributor><creatorcontrib>Puri, Dhruv</creatorcontrib><creatorcontrib>Nisar, Yasir Bin</creatorcontrib><creatorcontrib>Tshefu, Antoinette</creatorcontrib><creatorcontrib>Longombe, Adrien Lokangaka</creatorcontrib><creatorcontrib>Esamai, Fabian</creatorcontrib><creatorcontrib>Marete, Irene</creatorcontrib><creatorcontrib>Ayede, Adejumoke Idowu</creatorcontrib><creatorcontrib>Adejuyigbe, Ebunoluwa A</creatorcontrib><creatorcontrib>Wammanda, Robinson D</creatorcontrib><creatorcontrib>Qazi, Shamim Ahmad</creatorcontrib><creatorcontrib>Bahl, Rajiv</creatorcontrib><title>Prevalence of clinical signs of possible serious bacterial infection and mortality associated with them from population-based surveillance of young infants from birth to 2 months of age</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Community-based data on the prevalence of clinical signs of possible serious bacterial infection (PSBI) and the mortality associated with them are scarce. The aim was to examine the prevalence for each sign of infection and mortality associated with infants in the first two months of life, using community surveillance through community health workers (CHW).
We used population-based surveillance data of infants up to two months of age from the African Neonatal Sepsis Trial (AFRINEST). In this study, CHWs visited infants up to 10 times during the first two months of life at five sites in three sub-Saharan African countries. CHW assessed the infant for signs of infection (local or systemic) and referred infants who presented with any sign of infection to a health facility. We used a longitudinal analysis to calculate the risk of death associated with the presence of a sign of infection at the time of the visit until the subsequent visit.
During the first two months of their life, CHWs visited 84,759 live-born infants at least twice. In 11,089 infants (13.1%), one or more signs of infection were identified, of which 237 (2.1%) died. A sign of infection was detected at 2.1% of total visits. In 52% of visits, infants had one or more sign of systemic infection, while 25% had fast breathing in 7-59 days period and 23% had a local infection. All signs of infection, including multiple signs, were more frequently seen in the first week of life. The risk of mortality was very low (0.2%) for local infections and fast breathing in 7-59 days old, it was low for fast breathing 0-6 days old (0.6%), high body temperature (0.7%) and severe chest indrawing (1.0%), moderate for low body temperature (4.9%) and stopped feeding well/not able to feed at all (5.0%) and high for movement only when stimulated or no movement at all (10%) and multiple signs of systemic infection (15.5%). The risk of death associated with most clinical signs was higher (1.5 to 9 times) in the first week of life than at later age, except for low body temperature (4 times lower) as well as high body temperature (2 times lower).
Signs of infections are common in the first two months of life. The mortality risk differs with clinical signs and can be grouped as very low (local infections, fast breathing 7-59 days), low (fever, severe chest indrawing and fast breathing 0-6 days), moderate (low body temperature and stopped feeding well/not able to feed at all) and high (for movements only on stimulation or no movements at all and multiple signs of infection). New treatment strategies that consider differential mortality risk could be developed and evaluated based on these findings.
The trial was registered with Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.</description><subject>Adolescents</subject><subject>Age</subject><subject>Aging</subject><subject>Bacterial diseases</subject><subject>Bacterial infections</subject><subject>Biology and Life Sciences</subject><subject>Body temperature</subject><subject>Children</subject><subject>Childrens health</subject><subject>Data analysis</subject><subject>Demographic aspects</subject><subject>Diagnosis</subject><subject>Direct reduction</subject><subject>Editing</subject><subject>Fatalities</subject><subject>Fever</subject><subject>Health risks</subject><subject>Health surveillance</subject><subject>Hospitals</subject><subject>Infants</subject><subject>Infections</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Meta-analysis</subject><subject>Methodology</subject><subject>Mortality</subject><subject>Mortality risk</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Patient outcomes</subject><subject>Pediatrics</subject><subject>People and Places</subject><subject>Public 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Lokangaka</au><au>Esamai, Fabian</au><au>Marete, Irene</au><au>Ayede, Adejumoke Idowu</au><au>Adejuyigbe, Ebunoluwa A</au><au>Wammanda, Robinson D</au><au>Qazi, Shamim Ahmad</au><au>Bahl, Rajiv</au><au>Marotta, Claudia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence of clinical signs of possible serious bacterial infection and mortality associated with them from population-based surveillance of young infants from birth to 2 months of age</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2021-02-24</date><risdate>2021</risdate><volume>16</volume><issue>2</issue><spage>e0247457</spage><epage>e0247457</epage><pages>e0247457-e0247457</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Community-based data on the prevalence of clinical signs of possible serious bacterial infection (PSBI) and the mortality associated with them are scarce. The aim was to examine the prevalence for each sign of infection and mortality associated with infants in the first two months of life, using community surveillance through community health workers (CHW).
We used population-based surveillance data of infants up to two months of age from the African Neonatal Sepsis Trial (AFRINEST). In this study, CHWs visited infants up to 10 times during the first two months of life at five sites in three sub-Saharan African countries. CHW assessed the infant for signs of infection (local or systemic) and referred infants who presented with any sign of infection to a health facility. We used a longitudinal analysis to calculate the risk of death associated with the presence of a sign of infection at the time of the visit until the subsequent visit.
During the first two months of their life, CHWs visited 84,759 live-born infants at least twice. In 11,089 infants (13.1%), one or more signs of infection were identified, of which 237 (2.1%) died. A sign of infection was detected at 2.1% of total visits. In 52% of visits, infants had one or more sign of systemic infection, while 25% had fast breathing in 7-59 days period and 23% had a local infection. All signs of infection, including multiple signs, were more frequently seen in the first week of life. The risk of mortality was very low (0.2%) for local infections and fast breathing in 7-59 days old, it was low for fast breathing 0-6 days old (0.6%), high body temperature (0.7%) and severe chest indrawing (1.0%), moderate for low body temperature (4.9%) and stopped feeding well/not able to feed at all (5.0%) and high for movement only when stimulated or no movement at all (10%) and multiple signs of systemic infection (15.5%). The risk of death associated with most clinical signs was higher (1.5 to 9 times) in the first week of life than at later age, except for low body temperature (4 times lower) as well as high body temperature (2 times lower).
Signs of infections are common in the first two months of life. The mortality risk differs with clinical signs and can be grouped as very low (local infections, fast breathing 7-59 days), low (fever, severe chest indrawing and fast breathing 0-6 days), moderate (low body temperature and stopped feeding well/not able to feed at all) and high (for movements only on stimulation or no movements at all and multiple signs of infection). New treatment strategies that consider differential mortality risk could be developed and evaluated based on these findings.
The trial was registered with Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>33626090</pmid><doi>10.1371/journal.pone.0247457</doi><tpages>e0247457</tpages><orcidid>https://orcid.org/0000-0002-9720-5699</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 1932-6203 |
ispartof | PloS one, 2021-02, Vol.16 (2), p.e0247457-e0247457 |
issn | 1932-6203 1932-6203 |
language | eng |
recordid | cdi_plos_journals_2492989950 |
source | DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
subjects | Adolescents Age Aging Bacterial diseases Bacterial infections Biology and Life Sciences Body temperature Children Childrens health Data analysis Demographic aspects Diagnosis Direct reduction Editing Fatalities Fever Health risks Health surveillance Hospitals Infants Infections Medicine Medicine and Health Sciences Meta-analysis Methodology Mortality Mortality risk Neonates Newborn babies Patient outcomes Pediatrics People and Places Public health Sepsis Signs |
title | Prevalence of clinical signs of possible serious bacterial infection and mortality associated with them from population-based surveillance of young infants from birth to 2 months of age |
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