title: Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions.
abstract: BACKGROUND
  Around one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity.
  
  
  METHODS
  A standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections.
  
  
  RESULTS
  For neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges.
  
  
  CONCLUSIONS
  Rapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups.
authors.forename: Aline
authors.initials: A
authors.lastname: Simen-Kapeu
authors.forename: Anna C
authors.initials: AC
authors.lastname: Seale
authors.forename: Steve
authors.initials: S
authors.lastname: Wall
authors.forename: Christabel
authors.initials: C
authors.lastname: Nyange
authors.forename: Shamim A
authors.initials: SA
authors.lastname: Qazi
authors.forename: Sarah G
authors.initials: SG
authors.lastname: Moxon
authors.forename: Mark
authors.initials: M
authors.lastname: Young
authors.forename: Grace
authors.initials: G
authors.lastname: Liu
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
authors.forename: Kim E
authors.initials: KE
authors.lastname: Dickson
authors.forename: Joy E
authors.initials: JE
authors.lastname: Lawn
mesh_terms: D000349:Africa; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000600:supply & distribution; D001208:Asia; D003256:Community Participation; D003695:Delivery of Health Care; D005260:Female; D006266:Health Education; D063005:Health Information Systems / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006291:Health Policy; D006297:Health Services Accessibility; D061889:Healthcare Financing; D006760:Hospitalization; D006801:Humans; D007231:Infant, Newborn; D007239:Infections / Q000175:diagnosis* / Q000188:drug therapy*; D007857:Leadership; D008297:Male; D010342:Patient Acceptance of Health Care; D017410:Practice Guidelines as Topic; D000078329:Workforce
chemical_list: D000900:Anti-Bacterial Agents