title: Improving the outcome of bacterial meningitis in newborn infants in Africa: reflections on recent progress.
abstract: OBJECTIVE
  There has been a reduction in overall under fives mortality (UFM) but neonatal mortality has not fallen at the same rate as for older children. Bacterial meningitis remains a common, often unrecognized and devastating illness in many African newborns with high mortality and morbidity. Further progress in reducing UFM has to focus on quality of care for neonates. Recent efforts to improve diagnosis, treatment and outcome are reviewed.
  
  
  RESULTS
  Diagnosis is often unsupported by laboratory tests and efforts have been made to improve the clinical diagnosis of bacterial meningitis. Simpler, robust bedside tests are being devised. The cause of bacterial meningitis is changing and first-line antimicrobial therapy and adjuvant therapies are evaluated. Programmes to reduce risk factors and prevent neonatal infections are identified.
  
  
  CONCLUSIONS
  Neonatal care needs to improve in first referral hospitals with simple, low-cost, validated measures provided as bundles of care for both mother and child. First-line antibiotic therapy must be reconsidered in the light of increased infections by multiresistant and Gram-negative bacteria. Studies are needed for effective and safe lengths of antimicrobial therapy, the role of adjuvant therapy and the best anticonvulsants to use.
authors.affiliation: Department of Paediatrics, College of Medicine and Queen Elizabeth Central Hospital, Blantyre, Malawi.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Molyneux
authors.forename: Queen
authors.initials: Q
authors.lastname: Dube
authors.forename: Laura
authors.initials: L
authors.lastname: Newberry
mesh_terms: D000349:Africa / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use*; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D006095:Gram-Positive Cocci / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007115:Immunization Schedule; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D018570:Risk Assessment; D013129:Spinal Puncture / Q000706:statistics & numerical data; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D002097:C-Reactive Protein