Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis
Identifieur interne : 001410 ( Pmc/Checkpoint ); précédent : 001409; suivant : 001411Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis
Auteurs : Anna C. Seale [Royaume-Uni, Kenya] ; Hannah Blencowe [Royaume-Uni] ; Alexander A. Manu [Royaume-Uni] ; Harish Nair [Royaume-Uni, Inde] ; Rajiv Bahl [Suisse] ; Shamim A. Qazi [Suisse] ; Anita K. Zaidi [Pakistan] ; James A. Berkley [Royaume-Uni, Kenya] ; Simon N. Cousens [Royaume-Uni] ; Joy E. Lawn [Royaume-Uni, États-Unis]Source :
- The Lancet. Infectious Diseases [ 1473-3099 ] ; 2014.
Abstract
Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America.
We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012.
We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1–9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4–12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million–8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million–4·2 million) in south Asia, 2·6 million (2·1 million–3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million–1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06–1·18) than girls. We estimated that there were 0·68 million (0·46 million–0·92 million) neonatal deaths associated with pSBI in 2012.
The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management.
The Wellcome Trust and the Bill & Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme.
Url:
DOI: 10.1016/S1473-3099(14)70804-7
PubMed: 24974250
PubMed Central: 4123782
Affiliations:
- Inde, Kenya, Pakistan, Royaume-Uni, Suisse, États-Unis
- Angleterre, District de Columbia, Grand Londres, Oxfordshire, Écosse
- Londres, Oxford, Édimbourg
- Université d'Oxford, Université d'Édimbourg
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Zaidi</name><affiliation wicri:level="1"><nlm:aff id="aff8">Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan</nlm:aff><country xml:lang="fr">Pakistan</country><wicri:regionArea>Department of Paediatrics and Child Health, Aga Khan University, Karachi</wicri:regionArea><wicri:noRegion>Karachi</wicri:noRegion></affiliation></author><author><name sortKey="Berkley, James A" sort="Berkley, James A" uniqKey="Berkley J" first="James A" last="Berkley">James A. 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Cousens</name><affiliation wicri:level="3"><nlm:aff id="aff3">Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Lawn, Joy E" sort="Lawn, Joy E" uniqKey="Lawn J" first="Joy E" last="Lawn">Joy E. 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Seale</name><affiliation wicri:level="4"><nlm:aff id="aff1">Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region><settlement type="city">Oxford</settlement></placeName><orgName type="university">Université d'Oxford</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">KEMRI-Wellcome Trust Centre for Geographic Medicine and Research–Coast, Kilifi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>KEMRI-Wellcome Trust Centre for Geographic Medicine and Research–Coast, Kilifi</wicri:regionArea><wicri:noRegion>Kilifi</wicri:noRegion></affiliation></author><author><name sortKey="Blencowe, Hannah" sort="Blencowe, Hannah" uniqKey="Blencowe H" first="Hannah" last="Blencowe">Hannah Blencowe</name><affiliation wicri:level="3"><nlm:aff id="aff3">Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Manu, Alexander A" sort="Manu, Alexander A" uniqKey="Manu A" first="Alexander A" last="Manu">Alexander A. Manu</name><affiliation wicri:level="3"><nlm:aff id="aff3">Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Nair, Harish" sort="Nair, Harish" uniqKey="Nair H" first="Harish" last="Nair">Harish Nair</name><affiliation wicri:level="4"><nlm:aff id="aff5">Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Population Health Sciences, University of Edinburgh, Edinburgh</wicri:regionArea><placeName><settlement type="city">Édimbourg</settlement><region type="country">Écosse</region><settlement type="city">Édimbourg</settlement></placeName><orgName type="university">Université d'Édimbourg</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6">Public Health Foundation of India, New Delhi, India</nlm:aff><country xml:lang="fr">Inde</country><wicri:regionArea>Public Health Foundation of India, New Delhi</wicri:regionArea><wicri:noRegion>New Delhi</wicri:noRegion></affiliation></author><author><name sortKey="Bahl, Rajiv" sort="Bahl, Rajiv" uniqKey="Bahl R" first="Rajiv" last="Bahl">Rajiv Bahl</name><affiliation wicri:level="1"><nlm:aff id="aff7">Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva</wicri:regionArea><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Qazi, Shamim A" sort="Qazi, Shamim A" uniqKey="Qazi S" first="Shamim A" last="Qazi">Shamim A. Qazi</name><affiliation wicri:level="1"><nlm:aff id="aff7">Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva</wicri:regionArea><wicri:noRegion>Geneva</wicri:noRegion></affiliation></author><author><name sortKey="Zaidi, Anita K" sort="Zaidi, Anita K" uniqKey="Zaidi A" first="Anita K" last="Zaidi">Anita K. Zaidi</name><affiliation wicri:level="1"><nlm:aff id="aff8">Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan</nlm:aff><country xml:lang="fr">Pakistan</country><wicri:regionArea>Department of Paediatrics and Child Health, Aga Khan University, Karachi</wicri:regionArea><wicri:noRegion>Karachi</wicri:noRegion></affiliation></author><author><name sortKey="Berkley, James A" sort="Berkley, James A" uniqKey="Berkley J" first="James A" last="Berkley">James A. Berkley</name><affiliation wicri:level="4"><nlm:aff id="aff1">Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford</wicri:regionArea><placeName><settlement type="city">Oxford</settlement><region type="country">Angleterre</region><region type="comté" nuts="2">Oxfordshire</region><settlement type="city">Oxford</settlement></placeName><orgName type="university">Université d'Oxford</orgName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">KEMRI-Wellcome Trust Centre for Geographic Medicine and Research–Coast, Kilifi, Kenya</nlm:aff><country xml:lang="fr">Kenya</country><wicri:regionArea>KEMRI-Wellcome Trust Centre for Geographic Medicine and Research–Coast, Kilifi</wicri:regionArea><wicri:noRegion>Kilifi</wicri:noRegion></affiliation></author><author><name sortKey="Cousens, Simon N" sort="Cousens, Simon N" uniqKey="Cousens S" first="Simon N" last="Cousens">Simon N. Cousens</name><affiliation wicri:level="3"><nlm:aff id="aff3">Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Lawn, Joy E" sort="Lawn, Joy E" uniqKey="Lawn J" first="Joy E" last="Lawn">Joy E. Lawn</name><affiliation wicri:level="3"><nlm:aff id="aff3">Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff4">Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff9">Saving Newborn Lives/Save the Children, Washington, DC, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Saving Newborn Lives/Save the Children, Washington, DC</wicri:regionArea><placeName><region type="state">District de Columbia</region></placeName></affiliation></author></analytic><series><title level="j">The Lancet. Infectious Diseases</title><idno type="ISSN">1473-3099</idno><idno type="eISSN">1474-4457</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><sec><title>Background</title><p>Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America.</p></sec><sec><title>Methods</title><p>We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012.</p></sec><sec><title>Findings</title><p>We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1–9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4–12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million–8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million–4·2 million) in south Asia, 2·6 million (2·1 million–3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million–1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06–1·18) than girls. We estimated that there were 0·68 million (0·46 million–0·92 million) neonatal deaths associated with pSBI in 2012.</p></sec><sec><title>Interpretation</title><p>The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management.</p></sec><sec><title>Funding</title><p>The Wellcome Trust and the Bill & Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Murray, Cj" uniqKey="Murray C">CJ Murray</name></author><author><name sortKey="Vos, T" uniqKey="Vos T">T Vos</name></author><author><name sortKey="Lozano, R" uniqKey="Lozano R">R Lozano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Blencowe, H" uniqKey="Blencowe H">H Blencowe</name></author><author><name sortKey="Vos, T" uniqKey="Vos T">T Vos</name></author><author><name sortKey="Lee, Ac" uniqKey="Lee A">AC Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liu, L" uniqKey="Liu L">L 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Lancet Infect Dis</journal-id><journal-id journal-id-type="iso-abbrev">Lancet Infect Dis</journal-id><journal-title-group><journal-title>The Lancet. Infectious Diseases</journal-title></journal-title-group><issn pub-type="ppub">1473-3099</issn><issn pub-type="epub">1474-4457</issn><publisher><publisher-name>Elsevier Science, The Lancet Pub. Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24974250</article-id><article-id pub-id-type="pmc">4123782</article-id><article-id pub-id-type="publisher-id">S1473-3099(14)70804-7</article-id><article-id pub-id-type="doi">10.1016/S1473-3099(14)70804-7</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, south Asia, and Latin America for 2012: a systematic review and meta-analysis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Seale</surname><given-names>Anna C</given-names></name><degrees>Dr</degrees><degrees>MRCPCH</degrees><email>anna.seale@ndm.ox.ac.uk</email><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff2" ref-type="aff">b</xref><xref rid="cor1" ref-type="corresp">*</xref></contrib><contrib contrib-type="author"><name><surname>Blencowe</surname><given-names>Hannah</given-names></name><degrees>MRCPCH</degrees><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Manu</surname><given-names>Alexander A</given-names></name><degrees>PhD</degrees><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Nair</surname><given-names>Harish</given-names></name><degrees>PhD</degrees><xref rid="aff5" ref-type="aff">e</xref><xref rid="aff6" ref-type="aff">f</xref></contrib><contrib contrib-type="author"><name><surname>Bahl</surname><given-names>Rajiv</given-names></name><degrees>PhD</degrees><xref rid="aff7" ref-type="aff">g</xref></contrib><contrib contrib-type="author"><name><surname>Qazi</surname><given-names>Shamim A</given-names></name><degrees>MD</degrees><xref rid="aff7" ref-type="aff">g</xref></contrib><contrib contrib-type="author"><name><surname>Zaidi</surname><given-names>Anita K</given-names></name><degrees>MD</degrees><xref rid="aff8" ref-type="aff">h</xref></contrib><contrib contrib-type="author"><name><surname>Berkley</surname><given-names>James A</given-names></name><degrees>FRCPCH</degrees><xref rid="aff1" ref-type="aff">a</xref><xref rid="aff2" ref-type="aff">b</xref></contrib><contrib contrib-type="author"><name><surname>Cousens</surname><given-names>Simon N</given-names></name><degrees>Prof</degrees><degrees>DipMathStat</degrees><xref rid="aff3" ref-type="aff">c</xref></contrib><contrib contrib-type="author"><name><surname>Lawn</surname><given-names>Joy E</given-names></name><degrees>Prof</degrees><degrees>FRCPCH</degrees><xref rid="aff3" ref-type="aff">c</xref><xref rid="aff4" ref-type="aff">d</xref><xref rid="aff9" ref-type="aff">i</xref></contrib><contrib contrib-type="author"><collab>for the pSBI Investigator Group</collab><xref rid="fn1" ref-type="fn">†</xref></contrib></contrib-group><aff id="aff1"><label>a</label>Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK</aff><aff id="aff2"><label>b</label>KEMRI-Wellcome Trust Centre for Geographic Medicine and Research–Coast, Kilifi, Kenya</aff><aff id="aff3"><label>c</label>Faculty of Epidemiology and Population Health UK, London School of Hygiene and Tropical Medicine, London, UK</aff><aff id="aff4"><label>d</label>Centre for Maternal, Adolescent, Reproductive and Child Health, London School of Hygiene and Tropical Medicine, London, UK</aff><aff id="aff5"><label>e</label>Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK</aff><aff id="aff6"><label>f</label>Public Health Foundation of India, New Delhi, India</aff><aff id="aff7"><label>g</label>Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland</aff><aff id="aff8"><label>h</label>Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan</aff><aff id="aff9"><label>i</label>Saving Newborn Lives/Save the Children, Washington, DC, USA</aff><author-notes><corresp id="cor1"><label>*</label>Correspondence to: Dr Anna Seale, Centre for Tropical Medicine, CCVTM, University of Oxford, Churchill Hospital, Old Road, Oxford OX3 7LJ, UK <email>anna.seale@ndm.ox.ac.uk</email></corresp><fn id="fn1"><label>†</label><p>Members listed at the end of the paper</p></fn></author-notes><pub-date pub-type="pmc-release"><day>25</day><month>6</month><year>2014</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="epub"><day>25</day><month>6</month><year>2014</year></pub-date><volume>14</volume><issue>8</issue><fpage>731</fpage><lpage>741</lpage><permissions><copyright-statement>© 2014 Seale et al. Open Access article distributed under the terms of CC BY</copyright-statement><copyright-year>2014</copyright-year><license><license-p>This document may be redistributed and reused, subject to <ext-link ext-link-type="uri" xlink:href="http://www.elsevier.com/wps/find/authorsview.authors/supplementalterms1.0">certain conditions</ext-link>.</license-p></license></permissions><abstract><title>Summary</title><sec><title>Background</title><p>Bacterial infections are a leading cause of the 2·9 million annual neonatal deaths. Treatment is usually based on clinical diagnosis of possible severe bacterial infection (pSBI). To guide programme planning, we have undertaken the first estimates of neonatal pSBI, by sex and by region, for sub-Saharan Africa, south Asia, and Latin America.</p></sec><sec><title>Methods</title><p>We included data for pSBI incidence in neonates of 32 weeks' gestation or more (or birthweight ≥1500 g) with livebirth denominator data, undertaking a systematic review and forming an investigator group to obtain unpublished data. We calculated pooled risk estimates for neonatal pSBI and case fatality risk, by sex and by region. We then applied these risk estimates to estimates of livebirths in sub-Saharan Africa, south Asia, and Latin America to estimate cases and associated deaths in 2012.</p></sec><sec><title>Findings</title><p>We included data from 22 studies, for 259 944 neonates and 20 196 pSBI cases, with most of the data (18 of the 22 studies) coming from the investigator group. The pooled estimate of pSBI incidence risk was 7·6% (95% CI 6·1–9·2%) and the case-fatality risk associated with pSBI was 9·8% (7·4–12·2). We estimated that in 2012 there were 6·9 million cases (uncertainty range 5·5 million–8·3 million) of pSBI in neonates needing treatment: 3·5 million (2·8 million–4·2 million) in south Asia, 2·6 million (2·1 million–3·1 million) in sub-Saharan Africa, and 0·8 million (0·7 million–1·0 million) in Latin America. The risk of pSBI was greater in boys (risk ratio 1·12, 95% CI 1·06–1·18) than girls. We estimated that there were 0·68 million (0·46 million–0·92 million) neonatal deaths associated with pSBI in 2012.</p></sec><sec><title>Interpretation</title><p>The need-to-treat population for pSBI in these three regions is high, with ten cases of pSBI diagnosed for each associated neonatal death. Deaths and disability can be reduced through improved prevention, detection, and case management.</p></sec><sec><title>Funding</title><p>The Wellcome Trust and the Bill & Melinda Gates Foundation through grants to Child Health Epidemiology Reference Group (CHERG) and Save the Children's Saving Newborn Lives programme.</p></sec></abstract></article-meta></front><floats-group><fig id="fig1"><label>Figure 1</label><caption><p>Possible severe bacterial infection (pSBI) and overlap with other clinical syndromes</p></caption><graphic xlink:href="gr1"></graphic></fig><fig id="fig2"><label>Figure 2</label><caption><p>Data search and extraction<xref rid="bib30" ref-type="bibr"><sup>30</sup></xref></p></caption><graphic xlink:href="gr2"></graphic></fig><fig id="fig3"><label>Figure 3</label><caption><p>Geographical distribution of the 22 included studies</p><p>The number of studies per country is shown in parentheses after country name.</p></caption><graphic xlink:href="gr3"></graphic></fig><fig id="fig4"><label>Figure 4</label><caption><p>Meta-analysis for possible severe bacterial infection incidence, by region</p><p>*As per random effects analysis.</p></caption><graphic xlink:href="gr4"></graphic></fig><fig id="fig5"><label>Figure 5</label><caption><p>Scatter plot of risk of possible severe bacterial infection and case fatality risk, indicating method of case identification</p><p>Outliers with a high case-fatality risk are labelled.</p></caption><graphic xlink:href="gr5"></graphic></fig><table-wrap id="tbl1" position="float"><label>Table 1</label><caption><p>Overview of the 22 included studies of possible severe bacterial infection</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th align="left"><bold>Country</bold></th><th align="left"><bold>Location</bold></th><th align="left"><bold>Rural or mixed (rural-urban)</bold></th><th align="left"><bold>Intervention</bold></th><th align="left"><bold>Neonatal mortality rate per 1000 livebirths</bold></th><th align="left"><bold>Year (median)</bold></th><th align="left"><bold>Period of data collection</bold></th><th align="left"><bold>Algorithm</bold><xref rid="tbl1fn1" ref-type="table-fn">*</xref></th><th align="left"><bold>Case ascertainment</bold></th></tr></thead><tbody><tr><td align="left">Mitra et al (unpublished)</td><td align="left">Bangladesh</td><td align="left">Sylhet</td><td align="left">Rural</td><td align="left">Cord cleansing with chlorhexidine</td><td align="left">28·3</td><td align="left">2008</td><td align="left">2007–09</td><td align="left">YICSS</td><td align="left">Visit on days 1, 3, 6, 9, and 15</td></tr><tr><td align="left">Broor et al<xref rid="bib38" ref-type="bibr"><sup>38</sup></xref></td><td align="left">India</td><td align="left">Ballabgarh, Haryana State</td><td align="left">Rural</td><td align="left">None</td><td align="left">37</td><td align="left">2003</td><td align="left">2001–04</td><td align="left">Danger sign or fast breathing, indrawing, nasal flaring, or grunting</td><td align="left">Visit on day 7</td></tr><tr><td align="left">MNHR<xref rid="bib39" ref-type="bibr"><sup>39</sup></xref></td><td align="left">India</td><td align="left">Nagpur District</td><td align="left">Mixed</td><td align="left">None (health registry)</td><td align="left">26·2</td><td align="left">2012</td><td align="left">2012</td><td align="left">YICSS adapted</td><td align="left">Visit on day 1 or 2 and on day 42</td></tr><tr><td align="left">MNHR<xref rid="bib39" ref-type="bibr"><sup>39</sup></xref></td><td align="left">India</td><td align="left">Belgaum district</td><td align="left">Mixed</td><td align="left">None (health registry)</td><td align="left">26·2</td><td align="left">2012</td><td align="left">2012</td><td align="left">YICSS adapted</td><td align="left">Visit on day 1 or 2 and on day 42</td></tr><tr><td align="left">Khanal et al<xref rid="bib40" ref-type="bibr"><sup>40</sup></xref></td><td align="left">Nepal</td><td align="left">Morang District</td><td align="left">Rural</td><td align="left">Community care</td><td align="left">33</td><td align="left">2006</td><td align="left">2005–07</td><td align="left">YICSS adapted; included skin and umbilicus infection</td><td align="left">Visit on days 1 and 60</td></tr><tr><td align="left">Saville et al<xref rid="bib37" ref-type="bibr"><sup>37</sup></xref></td><td align="left">Nepal</td><td align="left">Dhanusha</td><td align="left">Rural</td><td align="left">Community interventions</td><td align="left">32·5</td><td align="left">2009</td><td align="left">2007–11</td><td align="left">YICSS adapted to include umbilical and skin infection</td><td align="left">Visit on days 1, 3, 14, and 28</td></tr><tr><td align="left">Mullany et al<xref rid="bib36 bib41" ref-type="bibr"><sup>36,41</sup></xref></td><td align="left">Nepal</td><td align="left">Sarlahi District</td><td align="left">Rural</td><td align="left">Chlorhexidine skin and umbilicus cleansing</td><td align="left">32·1</td><td align="left">2004</td><td align="left">2002–06</td><td align="left">YICSS; any two criteria</td><td align="left">Visit on days 1, 2, 3, 4, 6, 8, 10, 12, 14, 21, and 28</td></tr><tr><td align="left">Zaidi et al<xref rid="bib27" ref-type="bibr"><sup>27</sup></xref></td><td align="left">Pakistan</td><td align="left">Karachi</td><td align="left">Mixed</td><td align="left">Outpatient management of infection</td><td align="left">45</td><td align="left">2005</td><td align="left">2003–08</td><td align="left">YICSS adapted</td><td align="left">Visit days 1, 3, 6, 15, and 30</td></tr><tr><td align="left">Bhutta et al<xref rid="bib42" ref-type="bibr"><sup>42</sup></xref></td><td align="left">Pakistan</td><td align="left">Matiari</td><td align="left">Rural</td><td align="left">None</td><td align="left">51</td><td align="left">2012</td><td align="left">2011–12</td><td align="left">YICSS</td><td align="left">Visit on days 1, 3, 6, 9, and 15</td></tr><tr><td align="left">Soofi et al (unpublished)</td><td align="left">Pakistan</td><td align="left">District Naushero Feroze</td><td align="left">Rural</td><td align="left">None</td><td align="left">44</td><td align="left">2011</td><td align="left">2010–12</td><td align="left">YICSS</td><td align="left">Visit on days 1, 3, 6, 9, and 15</td></tr><tr><td align="left">Simoes et al<xref rid="bib43" ref-type="bibr"><sup>43</sup></xref></td><td align="left">Indonesia</td><td align="left">West Java District</td><td align="left">Mixed</td><td align="left">None</td><td align="left">NA</td><td align="left">1999</td><td align="left">1998–2001</td><td align="left">YICSS adapted (excluding convulsions, poor feeding)</td><td align="left">Visit on days 7, 14, 21, and 28</td></tr><tr><td align="left">Turner et al<xref rid="bib44" ref-type="bibr"><sup>44</sup></xref></td><td align="left">Thai–Myanmar border</td><td align="left">Thai–Myanmar border</td><td align="left">Rural</td><td align="left">None</td><td align="left">15·9</td><td align="left">2009</td><td align="left">2009–10</td><td align="left">Fever or two signs of severe disease</td><td align="left">Visit on days 7 and 28</td></tr><tr><td align="left">Kirkwood et al<xref rid="bib45" ref-type="bibr"><sup>45</sup></xref></td><td align="left">Ghana</td><td align="left">Brong-Ahafo region</td><td align="left">Rural</td><td align="left">Community care</td><td align="left">32·3</td><td align="left">2009</td><td align="left">2008–09</td><td align="left">YICSS</td><td align="left">Three visits in first 7 days of life</td></tr><tr><td align="left">Berkley et al (unpublished)</td><td align="left">Kenya</td><td align="left">Kilifi District</td><td align="left">Rural</td><td align="left">None</td><td align="left">13·3</td><td align="left">2010</td><td align="left">2009–11</td><td align="left">YICSS</td><td align="left">Neonates admitted to district hospital</td></tr><tr><td align="left">MNHR<xref rid="bib39" ref-type="bibr"><sup>39</sup></xref></td><td align="left">Kenya</td><td align="left">Western Highlands</td><td align="left">Rural</td><td align="left">None (health registry)</td><td align="left">15·5</td><td align="left">2012</td><td align="left">2012</td><td align="left">YICSS adapted</td><td align="left">Visit on day 1 or 2 and on day 42</td></tr><tr><td align="left">Hamer et al (unpublished)</td><td align="left">Zambia</td><td align="left">Southern Province</td><td align="left">Rural</td><td align="left">Cord cleansing with chlorhexidine</td><td align="left">14·9</td><td align="left">2012</td><td align="left">2011–13</td><td align="left">YICSS adapted; including jaundice and umbilicus infection</td><td align="left">Visits on day 1, 4, 10, and 28</td></tr><tr><td align="left">MNHR<xref rid="bib39" ref-type="bibr"><sup>39</sup></xref></td><td align="left">Zambia</td><td align="left">Chongwe and Kafue District</td><td align="left">Mixed</td><td align="left">None (health registry)</td><td align="left">22·7</td><td align="left">2012</td><td align="left">2012</td><td align="left">YICSS adapted</td><td align="left">Visit on day 1 or 2 and on day 42</td></tr><tr><td align="left">Gill et al<xref rid="bib46" ref-type="bibr"><sup>46</sup></xref></td><td align="left">Zambia</td><td align="left">Lufwanyama District</td><td align="left">Rural</td><td align="left">Community care</td><td align="left">30·4</td><td align="left">2007</td><td align="left">2006–08</td><td align="left">YICSS</td><td align="left">At routine contact for postpartum visits</td></tr><tr><td align="left">MNHR<xref rid="bib39" ref-type="bibr"><sup>39</sup></xref></td><td align="left">Argentina</td><td align="left">Corrientes and Santiago Districts</td><td align="left">Rural</td><td align="left">None (health registry)</td><td align="left">8·2</td><td align="left">2012</td><td align="left">2012</td><td align="left">YICSS adapted</td><td align="left">Visit on days 1 or 2 and on day 42</td></tr><tr><td align="left">MNHR<xref rid="bib39" ref-type="bibr"><sup>39</sup></xref></td><td align="left">Guatemala</td><td align="left">Chimaltenango District</td><td align="left">Mixed</td><td align="left">None (health registry)</td><td align="left">25·2</td><td align="left">2012</td><td align="left">2012</td><td align="left">YICSS adapted</td><td align="left">Visit on day 1 or 2 and on day 42</td></tr><tr><td align="left">Bruce et al<xref rid="bib47 bib48" ref-type="bibr"><sup>47,48</sup></xref></td><td align="left">Guatemala</td><td align="left">Highlands</td><td align="left">Rural</td><td align="left">Reducing indoor air pollution</td><td align="left">N/A</td><td align="left">2008</td><td align="left">2002–04</td><td align="left">YICSS (except indrawing)</td><td align="left">Visit days 7, 14, 21, and 28</td></tr><tr><td align="left">Tinoco et al (unpublished)</td><td align="left">Peru</td><td align="left">Lima, Tumbes, Cuzco, Puerto Maldonado</td><td align="left">Mixed</td><td align="left">None</td><td align="left">9</td><td align="left">2010</td><td align="left">2009–11</td><td align="left">Influenza-like illness</td><td align="left">Visit three times per week</td></tr></tbody></table><table-wrap-foot><fn><p>MNHR=Maternal and Newborn Health Registry. NA=not applicable. YICSS=Young Infants Clinical Signs Study.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl1fn1"><label>*</label><p>See <xref rid="sec1" ref-type="sec">appendix</xref> for further information.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tbl2" position="float"><label>Table 2</label><caption><p>Summary pooled incidence risk estimates from meta-analyses, by region</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th></th><th align="left"><bold>South Asia</bold></th><th align="left"><bold>Sub-Saharan Africa</bold></th><th align="left"><bold>Latin America</bold></th><th align="left"><bold>Overall</bold></th></tr></thead><tbody><tr><td colspan="6" align="left"><bold>Livebirths ≥32 weeks (n)</bold><xref rid="bib35" ref-type="bibr"><sup>35</sup></xref></td></tr><tr><td colspan="2" align="left">Total</td><td align="left">46 000 000</td><td align="left">34 100 000</td><td align="left">10 800 000</td><td align="left">91 000 000</td></tr><tr><td colspan="2" align="left">Boys</td><td align="left">23 700 000</td><td align="left">17 400 000</td><td align="left">5 500 000</td><td align="left">47 000 000</td></tr><tr><td colspan="2" align="left">Girls</td><td align="left">22 300 000</td><td align="left">16 700 000</td><td align="left">5 300 000</td><td align="left">44 000 000</td></tr><tr><td colspan="6" align="left"><bold>Studies (n)</bold></td></tr><tr><td colspan="2" align="left">Study sites</td><td align="left">12</td><td align="left">6</td><td align="left">4</td><td align="left">22</td></tr><tr><td colspan="2" align="left">Study population</td><td align="left">169 431</td><td align="left">80 752</td><td align="left">9761</td><td align="left">259 944</td></tr><tr><td colspan="2" align="left">pSBI cases</td><td align="left">15 027</td><td align="left">3989</td><td align="left">1180</td><td align="left">20 196</td></tr><tr><td colspan="6" align="left">pSBI incidence risk (95% CI)</td></tr><tr><td></td><td align="left">Total</td><td align="left">0·072 (0·050–0·093)</td><td align="left">0·062 (0·041–0·083)</td><td align="left">0·117 (0·076–0·159)</td><td align="left">0·076 (0·061–0·092)</td></tr><tr><td></td><td align="left">Boys</td><td align="left">0·085 (0.061–0·108)</td><td align="left">0·069 (0·042–0·095)</td><td align="left">0·149 (0·103–0·195)</td><td align="left">0·089 (0·071–0·108)</td></tr><tr><td></td><td align="left">Girls</td><td align="left">0·076 (0·055–0·097)</td><td align="left">0·064 (0·038–0·090)</td><td align="left">0·118 (0·076–0·160)</td><td align="left">0·077 (0·062–0.096)</td></tr><tr><td colspan="6" align="left">pSBI case fatality risk (95% CI)</td></tr><tr><td></td><td align="left">Total</td><td align="left">0·087 (0·056–0·118)</td><td align="left">0·141 (0·072–0·210)</td><td align="left">0·094 (0·063–0·125)</td><td align="left">0·098 (0·074–0·122)</td></tr><tr><td></td><td align="left">Boys</td><td align="left">0·093 (0·059–0·128)</td><td align="left">0·137 (0·061–0·213)</td><td align="left">0·111 (0·086–0·136)</td><td align="left">0·103 (0·075–0·130)</td></tr><tr><td></td><td align="left">Girls</td><td align="left">0·076 (0·047–0·104)</td><td align="left">0·152 (0·061–0·242)</td><td align="left">0·078 (0·033–0·122)</td><td align="left">0·090 (0·065–0·114)</td></tr></tbody></table><table-wrap-foot><fn><p>pBSI=possible severe bacterial infection.</p></fn></table-wrap-foot></table-wrap><table-wrap id="tbl3" position="float"><label>Table 3</label><caption><p>Estimates of cases of possible severe bacterial infection by region and sex</p></caption><table frame="hsides" rules="groups"><thead><tr><th></th><th align="left"><bold>South Asia</bold></th><th align="left"><bold>Sub-Saharan Africa</bold></th><th align="left"><bold>Latin America</bold></th><th align="left"><bold>Total</bold><xref rid="tbl3fn1" ref-type="table-fn">*</xref></th></tr></thead><tbody><tr><td colspan="5" align="left"><bold>pSBI cases</bold></td></tr><tr><td align="left">Total in millions</td><td align="left">3·5 (2·8–4·2)</td><td align="left">2·6 (2·1–3·1)</td><td align="left">0·8 (0·7–1·0)</td><td align="left">6·9 (5·5–8·3)</td></tr><tr><td align="left">Male cases in millions<xref rid="tbl3fn2" ref-type="table-fn">†</xref></td><td align="left">1·9 (1·5–2·4)</td><td align="left">1·4 (1·1–1·8)</td><td align="left">0·4 (0·4–0·6)</td><td align="left">3·7 (3·0–4·7)</td></tr><tr><td align="left">Female cases in millions<xref rid="tbl3fn2" ref-type="table-fn">†</xref></td><td align="left">1·6 (1·2–2·0)</td><td align="left">1·2 (0·9–1·5)</td><td align="left">0·4 (0·3–0·5)</td><td align="left">3·2 (2·5–3·9)</td></tr><tr><td colspan="5" align="left"><bold>pSBI deaths</bold></td></tr><tr><td align="left">Total</td><td align="left">340 000 (230 000–470 000)</td><td align="left">250 000 (170 000–340 000)</td><td align="left">00 000 (50 000–110 000)</td><td align="left">680 000 (460 000–920 000)</td></tr><tr><td align="left">Male cases<xref rid="tbl3fn3" ref-type="table-fn">‡</xref></td><td align="left">190 000 (130 000–260 000)</td><td align="left">140 000 (90 000–190 000)</td><td align="left">40 000 (30 000–50 000)</td><td align="left">370 000 (280 000–460 000)</td></tr><tr><td align="left">Female cases<xref rid="tbl3fn3" ref-type="table-fn">‡</xref></td><td align="left">160 000 (110 000–210 000)</td><td align="left">120 000 (80 000–160 000)</td><td align="left">40 000 (30 000–50 000)</td><td align="left">310 000 (220 000–360 000)</td></tr></tbody></table><table-wrap-foot><fn><p>Data are cases (uncertainty range). pBSI=possible severe bacterial infection.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl3fn1"><label>*</label><p>Totals for all regions are based on unrounded estimates of regional cases.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl3fn2"><label>†</label><p>Male and female pSBI cases calculated from pSBI incidence risk (<xref rid="tbl2" ref-type="table">table 2</xref>) adjusted for sex, assuming that male babies were at a 12% increased risk as per the risk ratio.</p></fn></table-wrap-foot><table-wrap-foot><fn id="tbl3fn3"><label>‡</label><p>Male and female deaths calculated from sex-specific pSBI cases and overall case-fatality risk.</p></fn></table-wrap-foot></table-wrap></floats-group></pmc><affiliations><list><country><li>Inde</li><li>Kenya</li><li>Pakistan</li><li>Royaume-Uni</li><li>Suisse</li><li>États-Unis</li></country><region><li>Angleterre</li><li>District de Columbia</li><li>Grand Londres</li><li>Oxfordshire</li><li>Écosse</li></region><settlement><li>Londres</li><li>Oxford</li><li>Édimbourg</li></settlement><orgName><li>Université d'Oxford</li><li>Université d'Édimbourg</li></orgName></list><tree><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Seale, Anna C" sort="Seale, Anna C" uniqKey="Seale A" first="Anna C" last="Seale">Anna C. Seale</name></region><name sortKey="Berkley, James A" sort="Berkley, James A" uniqKey="Berkley J" first="James A" last="Berkley">James A. Berkley</name><name sortKey="Blencowe, Hannah" sort="Blencowe, Hannah" uniqKey="Blencowe H" first="Hannah" last="Blencowe">Hannah Blencowe</name><name sortKey="Cousens, Simon N" sort="Cousens, Simon N" uniqKey="Cousens S" first="Simon N" last="Cousens">Simon N. Cousens</name><name sortKey="Lawn, Joy E" sort="Lawn, Joy E" uniqKey="Lawn J" first="Joy E" last="Lawn">Joy E. Lawn</name><name sortKey="Lawn, Joy E" sort="Lawn, Joy E" uniqKey="Lawn J" first="Joy E" last="Lawn">Joy E. Lawn</name><name sortKey="Manu, Alexander A" sort="Manu, Alexander A" uniqKey="Manu A" first="Alexander A" last="Manu">Alexander A. Manu</name><name sortKey="Nair, Harish" sort="Nair, Harish" uniqKey="Nair H" first="Harish" last="Nair">Harish Nair</name></country><country name="Kenya"><noRegion><name sortKey="Seale, Anna C" sort="Seale, Anna C" uniqKey="Seale A" first="Anna C" last="Seale">Anna C. Seale</name></noRegion><name sortKey="Berkley, James A" sort="Berkley, James A" uniqKey="Berkley J" first="James A" last="Berkley">James A. Berkley</name></country><country name="Inde"><noRegion><name sortKey="Nair, Harish" sort="Nair, Harish" uniqKey="Nair H" first="Harish" last="Nair">Harish Nair</name></noRegion></country><country name="Suisse"><noRegion><name sortKey="Bahl, Rajiv" sort="Bahl, Rajiv" uniqKey="Bahl R" first="Rajiv" last="Bahl">Rajiv Bahl</name></noRegion><name sortKey="Qazi, Shamim A" sort="Qazi, Shamim A" uniqKey="Qazi S" first="Shamim A" last="Qazi">Shamim A. Qazi</name></country><country name="Pakistan"><noRegion><name sortKey="Zaidi, Anita K" sort="Zaidi, Anita K" uniqKey="Zaidi A" first="Anita K" last="Zaidi">Anita K. Zaidi</name></noRegion></country><country name="États-Unis"><region name="District de Columbia"><name sortKey="Lawn, Joy E" sort="Lawn, Joy E" uniqKey="Lawn J" first="Joy E" last="Lawn">Joy E. Lawn</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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