title: Community-based management and outcome of omphalitis in newborns in Karachi, Pakistan.
abstract: OBJECTIVE
  To describe the clinical profile and outcome in newborns with omphalitis managed with home or clinic-based therapy.
  
  
  METHODS
  The descriptive study was conducted from September 2004 to August 2007 in three low-income communities in Karachi, Pakistan. Newborns with omphalitis detected by community health workers through active surveillance were referred to local clinics. Those with physician-confirmed omphalitis were treated for 7 days with topical gentian violet or oral cephalexin (as monotherapy) or topical gentian violet and oral cephalexin (combination therapy) at physician discretion, or injectable therapy (procaine penicillin and gentamicin) if clinical signs of sepsis were also present and family refused hospital referral. Follow-up was at 48-72 hours and 7 days. SPSS 16 was used for statistical analysis.
  
  
  RESULTS
  Among 1083 newborns with omphalitis, 578 (53.4%) had peri-umbilical cellulitis without purulent discharge; 365 (33.7%) had purulent discharge (with or without cellulitis); and 140 (13%) had omphalitis with sepsis Review of outcome data at one week showed that among 943 newborns without signs of sepsis, 938 (99.5%) had improved; 2 (0.2%) died, and 2 (0.2%) were lost to follow-up. There were 5 (3.6%) therapy failures, among 140 newborns with omphalitis and sepsis managed with parenteral antibiotics at 48 hours, but 139 (99.2%) had improved by one week, while 1 (0.8%) died.
  
  
  CONCLUSIONS
  In resource-constrained environments, omphalitis can be managed in the community with minimal need for hospital referral. Further research to define optimal therapeutic regimens is needed.
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi. farah.qamar@aku.edu
authors.forename: Farah Naz
authors.initials: FN
authors.lastname: Qamar
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi.
authors.forename: Shiyam Sundar
authors.initials: SS
authors.lastname: Tikmani
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi.
authors.forename: Fatima
authors.initials: F
authors.lastname: Mir
authors.affiliation: Department of Paediatrics and Child Health, Aga Khan University, Karachi.
authors.forename: Anita Kazmi Mehdi
authors.initials: AK
authors.lastname: Zaidi
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002481:Cellulitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D002506:Cephalexin / Q000008:administration & dosage*; D003153:Community Health Services; D005260:Female; D005840:Gentian Violet / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010154:Pakistan; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014472:Umbilicus / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D005840:Gentian Violet; D002506:Cephalexin