title: Management of newborn infections in primary care settings: a review of the evidence and implications for policy?
abstract: BACKGROUND
  Long-term, sustainable programs to address high incidence and death rates from neonatal infections are required for improving child survival. There is an urgent need to define the role of community-based management for neonates with serious bacterial infections--both at home and at first-level facilities.
  
  
  METHODS
  We reviewed available evidence for community-based antibiotic management strategies for serious neonatal infections.
  
  
  RESULTS
  Nine distinct studies contributing data for community-based management of neonatal pneumonia and sepsis were identified. In a pooled analysis of 5 controlled trials of community-based management of neonatal pneumonia (4 using cotrimoxazole, 1 ampicillin, or penicillin), all-cause neonatal mortality showed 27% [95% confidence interval (CI): 18%-35%] reduction and pneumonia-specific mortality, 42% (95% CI: 22%-57%). Substantial reductions in neonatal mortality have been demonstrated in a nonrandomized controlled study in rural India (62% reduction, P < 0.001) and in a cluster randomized trial in rural Bangladesh (34% reduction, 95% CI: 7%-53%). Reduced case fatalities (0%-3%) with community-based management of neonatal sepsis were observed in 2 small uncontrolled studies from India and Guatemala and a recent randomized trial from Pakistan.
  
  
  CONCLUSIONS
  Although methodological limitations preclude estimating the precise contribution of antibiotics toward neonatal mortality reduction in community settings in low income countries, available data suggest substantial benefit of case management approaches using antibiotics for neonatal sepsis in such settings.
authors.affiliation: Department of Paediatrics and Child Health, The Aga Khan University, Karachi, Pakistan. zulfiqar.bhutta@aku.edu
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: Anita K M
authors.initials: AK
authors.lastname: Zaidi
authors.forename: Durrane
authors.initials: D
authors.lastname: Thaver
authors.forename: Quratulain
authors.initials: Q
authors.lastname: Humayun
authors.forename: Samana
authors.initials: S
authors.lastname: Ali
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000628:therapy*; D003153:Community Health Services; D006801:Humans; D007231:Infant, Newborn; D011320:Primary Health Care; D011640:Public Policy
chemical_list: D000900:Anti-Bacterial Agents