Cape Town — A six-year study conducted by the Baby GERMS-SA team, led by experts from the National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service, has found that newborn mortality rates remain high despite efforts to reduce deaths in children aged younger than 5 years. Additionally, 42% of deaths were found to occur in the sub-Saharan Africa region with infections found to be the leading cause of these deaths.
The study, which has been noted as the first national population-level analysis of invasive newborn infections in the local public health sector and was funded by the Bill & Melinda Gates Foundation, analysed samples of blood and cerebrospinal fluid culture pathology reports from newborn babies at 256 public-sector hospitals. It found that the majority of infections occurred 3 days after birth and that many were caused by multi-drug-resistant bacteria. The findings suggest these to have occurred in hospitals specifically.
The study targeted babies younger than 28 days old who were admitted to facilities between January 2014 and December 2019. Over the six-year research period, nearly 38,000 cases of infection were diagnosed, of which the average age of babies affected was 7-days-old. Additionally, 70% of cases were found to result from three specific bacterial pathogens: Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus, none of which can be prevented by vaccines. A large number of the bacteria identified were also noted to to be resistant to antibiotics used to treat neonatal infections while two-thirds of cases were diagnosed in hospitals in the provinces of Gauteng and KwaZulu-Natal.
The study also found a rise in the national annual incidence risk over the 6 years of study along with the fact that nearly half of neonatal cases of infection were diagnosed at regional hospitals. Late-onset infections, theorised to be most likely be acquired in hospitals, were higher than those reported in resource-rich nations.
As a whole, the study serves to address a critical gap in knowledge. Further, it will serve as a base from which future measurements and interventions in South Africa can be gauged against. Further, in 2019, it was discovered by the Global Anti-biotic Research & Development Partnership (GARDP) that, out of 1.3 million deaths caused by antimicrobial resistance, 140,000 were newborn fatalities.
"There is an urgent need to develop and ensure access to novel antibiotic treatments to keep pace with rising rates of drug-resistant infections among babies with neonatal sepsis," said Manica Balasegaram, Executive Director of GARDP. "We are incredibly grateful to our numerous partners and funders who have given us essential support to make this observational study possible. Guided by these new insights, we have the opportunity to place children at the centre of the international response to antibiotic resistance."
According to Health-e, Professor Angela Dramowski from the University of Stellenbosch expressed concern that drug-resistant pathogens are becoming more prevalent in neo-natal units.
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"We have so many vulnerable babies, it could have disastrous outcomes. Infection prevention and control becomes exceptionally important to prevent this spreading more widely ... Pathogens that were easily treated ten years ago now require increasingly expensive, toxic drugs to treat, and have limited or lesser chance of successful outcomes. This is because they are not necessarily the most effective drugs. They are the only drugs we have left. In the past, we could get away with treating newborn babies with a single antibiotic. Now we often need to give three drugs for the best possible outcome. When you add so many antibiotics together, the added effect and potential for complications and adverse events is higher," Dramowski said.
