Adherence to World Health Organisation guidelines for treatment of early onset neonatal sepsis in low-income settings; a cohort study in Nepal

Abstract Background Neonatal sepsis is one of the major causes of death during the first month of life and early empirical treatment with injectable antibiotics is a life-saving intervention. Adherence to World Health Organisation guidelines on first line antibiotics is crucial to mitigate the risks of increased antimicrobial resistance. The aim of this paper was to evaluate if treatment of early onset neonatal sepsis in a low-income facility setting observe current guidelines and if compliance is influenced by contextual factors. Methods This cohort study used data on antimicrobial treatment of neonatal sepsis onset within 72 hours of life from 12 regional hospitals participating in a scale-up trial of a neonatal resuscitation quality improvement package intervention in Nepal. Infants treated according to guidelines were compared with those receiving other antimicrobials. A multiple logistic regression analysis adjusted for the intervention and time trend was applied. Results 1,564 infants with a preliminary diagnosis of early onset sepsis were included. A majority (74.9%) were treated according to guidelines and adherence was increasing over time. Infants born at larger facilities (adjusted Odds Ratio 5.6), those that were inborn (adjusted Odds Ratio 1.97) or belonging to a family of dis-advantaged caste (adjusted Odds Ratio 2.15) had higher odds for treatment according to guidelines. A clinical presentation of lethargy or tachypnoea was associated with adherence to guidelines. Conclusion Adherence to guidelines for antibiotic treatment of early neonatal sepsis was moderately high in this low-income setting. Odds for observing guidelines increased with facility size, for inborn infants and if the family belonged to a dis-advantaged caste. Cefotaxime was a common alternative choice when guidelines were not followed, highly relevant for the risk of increased antimicrobial resistance.

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Adherence to World Health Organisation guidelines for treatment of early onset neonatal sepsis in low-income settings; a cohort study in Nepal

BMC Infectious Diseases ◽

10.1186/s12879-020-05361-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Beatrice Ekman ◽

Prajwal Paudel ◽

Omkar Basnet ◽

Ashish KC ◽

Johan Wrammert

Keyword(s):

Cohort Study ◽

Antimicrobial Resistance ◽

Low Income ◽

Neonatal Sepsis ◽

Early Onset ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

World Health Organisation ◽

World Health ◽

Adherence To Guidelines

Abstract Background Neonatal sepsis is one of the major causes of death during the first month of life and early empirical treatment with injectable antibiotics is a life-saving intervention. Adherence to World Health Organisation guidelines on first line antibiotics is crucial to mitigate the risks of increased antimicrobial resistance. The aim of this paper was to evaluate if treatment of early onset neonatal sepsis in a low-income facility setting observe current guidelines and if compliance is influenced by contextual factors. Methods This cohort study used data on antimicrobial treatment of neonatal sepsis onset within 72 h of life from 12 regional hospitals participating in a scale-up trial of a neonatal resuscitation quality improvement package intervention in Nepal. Infants treated according to guidelines were compared with those receiving other antimicrobials. A multiple logistic regression analysis adjusted for the intervention and time trend was applied. Results 1564 infants with a preliminary diagnosis of early onset sepsis were included. A majority (74.9%) were treated according to guidelines and adherence was increasing over time. Infants born at larger facilities (adjusted Odds Ratio 5.6), those that were inborn (adjusted Odds Ratio 1.97) or belonging to a family of dis-advantaged caste (adjusted Odds Ratio 2.15) had higher odds for treatment according to guidelines. A clinical presentation of lethargy or tachypnoea was associated with adherence to guidelines. Conclusion Adherence to guidelines for antibiotic treatment of early neonatal sepsis was moderately high in this low-income setting. Odds for observing guidelines increased with facility size, for inborn infants and if the family belonged to a dis-advantaged caste. Cefotaxime was a common alternative choice when guidelines were not followed, highly relevant for the risk of increased antimicrobial resistance. Trial registration ISRCTN, ISRCTN30829654, registered 17th of May, 2017.

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Adherence to World Health Organisation guidelines for treatment of early onset neonatal sepsis in low-income settings; a cohort study in Nepal

10.21203/rs.3.rs-19505/v1 ◽

2020 ◽

Author(s):

Beatrice Ekman ◽

Prajwal Paudel ◽

Omkar Basnet ◽

KC Ashish ◽

J. Wrammert

Keyword(s):

Cohort Study ◽

Antimicrobial Resistance ◽

Low Income ◽

Neonatal Sepsis ◽

Early Onset ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

World Health Organisation ◽

World Health ◽

Adherence To Guidelines

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Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study (Preprint)

10.2196/preprints.16061 ◽

2019 ◽

Author(s):

Jenevieve Opoku ◽

Rupali K Doshi ◽

Amanda D Castel ◽

Ian Sorensen ◽

Michael Horberg ◽

...

Keyword(s):

Cohort Study ◽

Health Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hiv Care ◽

Disease Stage ◽

People Living With Hiv ◽

Hiv Disease ◽

Persons Living With Hiv ◽

Living With Hiv

BACKGROUND HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. OBJECTIVE The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). METHODS Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. RESULTS There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). CONCLUSIONS These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required.

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Seroprevalence of SARS-CoV-2, Symptom Profiles and Sero-Neutralization in a Suburban Area, France

Viruses ◽

10.3390/v13061076 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1076

Author(s):

Anne Gégout Petit ◽

Hélène Jeulin ◽

Karine Legrand ◽

Nicolas Jay ◽

Agathe Bochnakian ◽

...

Keyword(s):

Odds Ratio ◽

World Health Organisation ◽

World Health ◽

Preventive Effect ◽

Neutralization Activity ◽

Symptom Profiles ◽

The World ◽

Household Members ◽

Total Immunoglobulin

The World Health Organisation recommends monitoring the circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We investigated anti–SARS-CoV-2 total immunoglobulin (IgT) antibody seroprevalence and in vitro sero-neutralization in Nancy, France, in spring 2020. Individuals were randomly sampled from electoral lists and invited with household members over 5 years old to be tested for anti–SARS-CoV-2 (IgT, i.e., IgA/IgG/IgM) antibodies by ELISA (Bio-rad); the sero-neutralization activity was evaluated on Vero CCL-81 cells. Among 2006 individuals, the raw seroprevalence was 2.1% (95% confidence interval 1.5 to 2.9), was highest for 20- to 34-year-old participants (4.7% (2.3 to 8.4)), within than out of socially deprived area (2.5% vs. 1%, p = 0.02) and with than without intra-family infection (p < 10−6). Moreover, 25% of participants presented at least one COVID-19 symptom associated with SARS-CoV-2 positivity (p < 10−13), with highly discriminant anosmia or ageusia (odds ratio 27.8 [13.9 to 54.5]); 16.3% (6.8 to 30.7) of seropositive individuals were asymptomatic. Positive sero-neutralization was demonstrated in vitro for 31/43 seropositive subjects. Regarding the very low seroprevalence, a preventive effect of the lockdown in March 2020 can be assumed for the summer, but a second COVID-19 wave, as expected, could be subsequently observed in this poorly immunized population.

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Prevalence and associated factors of diarrhea among under-five children in Debre Berhan Town, Ethiopia 2018: A cross sectional study

10.21203/rs.2.13141/v3 ◽

2020 ◽

Author(s):

Sisay Shine ◽

Sindew Muhamud ◽

Solomon Adnew ◽

Alebachew Demelash ◽

Makda Abate

Keyword(s):

Low Income ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Cross Sectional Study ◽

Major Public Health Problem ◽

Sectional Study ◽

Cross Sectional ◽

Children Under Five ◽

Under Five ◽

Debre Berhan

Abstract Background: Diarrhea is responsible for 525,000 children under-five deaths and 1.7 billion cases globally and is the second leading cause of death among children under-five every year. It is a major public health problem in low income countries like Ethiopia. The main aim of this study was to assess the prevalence of diarrhea and associated risk factors among children under-five in Debre Berhan Town, Ethiopia. Methods: A community-based cross-sectional study was conducted in 420 parent or caretaker/children pairs in Debre Berhan town between 13–18 April 2018. A multi-stage sampling strategy was used to select the study participants. Data were collected using pre-tested and structured questionnaires. Data were entered in Epi-info computer software version 3.5.1 and exported to SPSS Window Version-16 for analysis. Adjusted odds ratio with 95% confidence intervals were used to assess the level of significance. Results: The two week prevalence of diarrhea among children under-five was 16.4% (69/351). Children aged 7-11 months (adjusted odds ratio (AOR): 4.2, 95% confidence interval (CI): 1.2 - 15.3), being the second-born child (AOR: 3.9, 95%CI: 1.8 - 8.5), not vaccinated against rotavirus (AOR: 10.3, 95%CI: 3.2 - 91.3) and feeding children by hand (AOR: 2.5, 95%CI: 1.1 - 6.1) were significant predictors of diarrhea. Conclusions: This study revealed that the two weeks period prevalence of diarrhea among children under-five years was 16.4%. Education programs on the importance of vaccination against rotavirus, increasing breast feeding frequency with complementary food after six months and the critical points of hand washing are recommended.

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Carbetocin versus Oxytocin for the Prevention of Postpartum Hemorrhage in Cesarean Deliveries: A Retrospective Study of Two Consecutive Periods

American Journal of Perinatology Reports ◽

10.1055/s-0040-1715163 ◽

2020 ◽

Vol 10 (03) ◽

pp. e241-e246

Author(s):

Pierre Delorme ◽

Gilles Kayem ◽

Hélène Legardeur ◽

Louise Anne Roux-Dessarps ◽

Guillaume Girard ◽

...

Keyword(s):

Multivariate Analysis ◽

Regression Analysis ◽

Cohort Study ◽

Postpartum Hemorrhage ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Single Injection ◽

Single Center ◽

Cesarean Deliveries ◽

The Difference

Abstract Objective The aim of the study is to investigate whether carbetocin prevents postpartum hemorrhage (PPH) more effectively than oxytocin Methods This historical retrospective single-center cohort study compares women who underwent cesarean deliveries during two periods. During period A, oxytocin was used as a 10-unit bolus immediately after delivery, with 20 units thereafter infused for 24 hours. During period B, carbetocin in a single 100-µg injection replaced this protocol. The main outcome was PPH, defined as a decline in hemoglobin of more than 2 g/dL after the cesarean. The analysis was performed on the overall population and then stratified by the timing of the cesareans (before or during labor). A logistic regression analysis was performed. Results This study included 1,796 women, 52% of whom had a cesarean before labor; 15% had a PPH. The crude PPH rate was lower in period B than in period A (13 vs. 17%, respectively, odds ratio 0.75, 95% confidence interval [CI]: 0.58–0.98). The difference was no longer significant in the multivariate analysis (adjusted odds ratio: 0.81, 95% CI 0.61–1.06). Results were similar when stratified by the timing of the cesareans (before or during labor). Conclusion Carbetocin is not superior to oxytocin in preventing PPH. However, it does provide the advantage of requiring a single injection.

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To screen or not to screen women for Group B Streptococcus (Streptococcus agalactiae) to prevent early onset sepsis in newborns: recent advances in the unresolved debate

Therapeutic Advances in Infectious Disease ◽

10.1177/2049936120942424 ◽

2020 ◽

Vol 7 ◽

pp. 204993612094242

Author(s):

Guduru Gopal Rao ◽

Priya Khanna

Keyword(s):

Risk Factor ◽

Antimicrobial Resistance ◽

Low Income ◽

Streptococcus Agalactiae ◽

Early Onset ◽

Group B Streptococcus ◽

Developed Countries ◽

Low Income Countries ◽

Early Onset Sepsis ◽

Group B

Streptococcus agalactiae, also known as Group B streptococcus (GBS) is the commonest cause of early onset sepsis in newborns in developed high-income countries. Intrapartum antimicrobial (antibiotic) prophylaxis (IAP) is recognized to be highly effective in preventing early onset Group B sepsis (EOGBS) in newborns. The key controversy is about the strategy that should be used to identify mothers who should receive IAP. There are two strategies that are followed in developed countries: screening-based or risk-factor-based identification of women requiring IAP. The debate regarding which of the two approaches is better has intensified in the recent years with concerns about antimicrobial resistance, effect on newborn’s microbiome and other adverse effects. In this review, we have discussed some of the key research papers published in the period 2015–2019 that have addressed the relative merits and disadvantages of screening versus risk-factor-based identification of women requiring IAP. Although screening-based IAP appears to be more efficacious than risk-based IAP, IAP-based prevention has several limitations including ineffectiveness in prevention of late-onset GBS infection in babies, premature and still births, impact of IAP on neonatal microbiota, emergence of antimicrobial resistance and difficulties in implementing IAP-based strategies in middle and low income countries. Alternative strategies, principally maternal immunization against GBS would circumvent use of IAP. However, no licensed vaccines are currently available for use.

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Prevalence and Antimicrobial Resistance of Mycoplasma genitalium Infection Among Women Living With Human Immunodeficiency Virus in South Africa: A Prospective Cohort Study

Clinical Infectious Diseases ◽

10.1093/cid/ciz045 ◽

2019 ◽

Vol 69 (5) ◽

pp. 873-876 ◽

Cited By ~ 2

Author(s):

Jason J Ong ◽

Mahlape Precious Magooa ◽

Admire Chikandiwa ◽

Helen Kelly ◽

Marie-Noelle Didelot ◽

...

Keyword(s):

Human Immunodeficiency Virus ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Mycoplasma Genitalium ◽

Cd4 Counts ◽

Immunodeficiency Virus ◽

Hiv 1

Abstract This prospective cohort study of 622 women living with human immunodeficiency virus (HIV) from Johannesburg (2012) detected Mycoplasma genitalium in 7.4% (95% confidence interval [CI]: 5.5–9.7, 46/622), with detection more likely with lower CD4 counts(adjusted odds ratio [AOR] 1.02 per 10 cells/μL decrease, 95% CI: 1.00–1.03) and higher plasma HIV-1 RNA (AOR 1.15 per log copies/mL increase, 95% CI: 1.03–1.27). No mutations for macrolide/quinolone resistance was detected.

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Using Intradermal Rabies Vaccine to Boost Immunity in People with Low Rabies Antibody Levels

Advances in Preventive Medicine ◽

10.4061/2011/601789 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 4

Author(s):

David Brown ◽

Anthony R. Fooks ◽

Martin Schweiger

Keyword(s):

Cohort Study ◽

Adverse Effects ◽

Vaccine Dose ◽

World Health Organisation ◽

Rabies Vaccine ◽

World Health ◽

Supporting Evidence ◽

The World ◽

Antibody Titres ◽

Antibody Levels

Intradermal rabies vaccine is recommended by the World Health Organisation, but not all countries, including England, follow this recommendation. A group of 12 adults in England previously given pre-exposure intradermal rabies vaccine were considered to be non-immune to rabies because their rabies antibody titres were known to be less than 0.5 IU/mL. A cohort study examined the immunizing effect of increasing the participants' cumulative dose of intradermal rabies to 2.0 IU. All patients subsequently demonstrated rabies antibody levels >0.5 IU⋅mL supporting evidence of adequate sero-conversion. No adverse effects of intradermal rabies vaccine boosting were noted. Within the limits of a small study the findings support the hypothesis that adequate levels of rabies antibody can be achieved by a schedule of intradermal injections delivered on at least three occasions with a cumulative rabies vaccine dose of 2.0 IU.

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Fluoroquinolones and isoniazid-resistant tuberculosis: implications for the 2018 WHO guidance

European Respiratory Journal ◽

10.1183/13993003.00982-2019 ◽

2019 ◽

Vol 54 (4) ◽

pp. 1900982 ◽

Cited By ~ 4

Author(s):

Helen R. Stagg ◽

Graham H. Bothamley ◽

Jennifer A. Davidson ◽

Heinke Kunst ◽

Maeve K. Lalor ◽

...

Keyword(s):

Logistic Regression ◽

Cohort Study ◽

Odds Ratio ◽

Treatment Effectiveness ◽

Drug Regimen ◽

Disease Recurrence ◽

World Health ◽

Phenotypic Resistance ◽

Health Organization ◽

The Impact

Introduction2018 World Health Organization (WHO) guidelines for the treatment of isoniazid (H)-resistant (Hr) tuberculosis recommend a four-drug regimen: rifampicin (R), ethambutol (E), pyrazinamide (Z) and levofloxacin (Lfx), with or without H ([H]RZE-Lfx). This is used once Hr is known, such that patients complete 6 months of Lfx (≥6[H]RZE-6Lfx). This cohort study assessed the impact of fluoroquinolones (Fq) on treatment effectiveness, accounting for Hr mutations and degree of phenotypic resistance.MethodsThis was a retrospective cohort study of 626 Hr tuberculosis patients notified in London, 2009–2013. Regimens were described and logistic regression undertaken of the association between regimen and negative regimen-specific outcomes (broadly, death due to tuberculosis, treatment failure or disease recurrence).ResultsOf 594 individuals with regimen information, 330 (55.6%) were treated with (H)RfZE (Rf=rifamycins) and 211 (35.5%) with (H)RfZE-Fq. The median overall treatment period was 11.9 months and median Z duration 2.1 months. In a univariable logistic regression model comparing (H)RfZE with and without Fqs, there was no difference in the odds of a negative regimen-specific outcome (baseline (H)RfZE, cluster-specific odds ratio 1.05 (95% CI 0.60–1.82), p=0.87; cluster NHS trust). Results varied minimally in a multivariable model. This odds ratio dropped (0.57, 95% CI 0.14–2.28) when Hr genotype was included, but this analysis lacked power (p=0.42).ConclusionsIn a high-income setting, we found a 12-month (H)RfZE regimen with a short Z duration to be similarly effective for Hr tuberculosis with or without a Fq. This regimen may result in fewer adverse events than the WHO recommendations.

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