title: Trends in the incidence of possible severe bacterial infection and case fatality rates in rural communities in Sub-Saharan Africa, South Asia and Latin America, 2010-2013: a multicenter prospective cohort study.
abstract: BACKGROUND
  Possible severe bacterial infections (pSBI) continue to be a leading cause of global neonatal mortality annually. With the recent publications of simplified antibiotic regimens for treatment of pSBI where referral is not possible, it is important to know how and where to target these regimens, but data on the incidence and outcomes of pSBI are limited.
  
  
  METHODS
  We used data prospectively collected at 7 rural community-based sites in 6 low and middle income countries participating in the NICHD Global Network's Maternal and Newborn Health Registry, between January 1, 2010 and December 31, 2013. Participants included pregnant women and their live born neonates followed for 6 weeks after delivery and assessed for maternal and infant outcomes.
  
  
  RESULTS
  In a cohort of 248,539 infants born alive between 2010 and 2013, 32,088 (13 %) neonates met symptomatic criteria for pSBI. The incidence of pSBI during the first 6 weeks of life varied 10 fold from 3 % (Zambia) to 36 % (Pakistan), and overall case fatality rates varied 8 fold from 5 % (Kenya) to 42 % (Zambia). Significant variations in incidence of pSBI during the study period, with proportions decreasing in 3 sites (Argentina, Kenya and Nagpur, India), remaining stable in 3 sites (Zambia, Guatemala, Belgaum, India) and increasing in 1 site (Pakistan), cannot be explained solely by changing rates of facility deliveries. Case fatality rates did not vary over time.
  
  
  CONCLUSIONS
  In a prospective population based registry with trained data collectors, there were wide variations in the incidence and case fatality of pSBI in rural communities and in trends over time. Regardless of these variations, the burden of pSBI is still high and strategies to implement timely diagnosis and treatment are still urgently needed to reduce neonatal mortality.
  
  
  BACKGROUND
  The study was registered at ClinicalTrials.gov ( NCT01073475 ).
authors.affiliation: Massachusetts General Hospital for Children, Boston, MA, USA. phibberd@mgh.harvard.edu.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
authors.affiliation: RTI International, Research Triangle Park, North Carolina, USA.
authors.forename: Nellie I
authors.initials: NI
authors.lastname: Hansen
authors.affiliation: Massachusetts General Hospital for Children, Boston, MA, USA.
authors.forename: Marie E
authors.initials: ME
authors.lastname: Wang
authors.affiliation: Jawaharlal Nehru Medical College, Belgaum, India.
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.affiliation: Moi University, Eldoret, Kenya.
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.affiliation: University of Zambia, Lusaka, Zambia.
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.affiliation: Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala.
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.affiliation: Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Althabe
authors.affiliation: Christiana Health Care, Newark, DE, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.affiliation: Columbia University, New York, NY, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.affiliation: Indiana University School of Medicine, Indianapolis, IN, USA.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Liechty
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.affiliation: University of Colorado Health Sciences Center, Denver, CO, USA.
authors.forename: K Michael
authors.initials: KM
authors.lastname: Hambidge
authors.affiliation: University of Colorado Health Sciences Center, Denver, CO, USA.
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Krebs
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, LA, USA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
authors.affiliation: RTI International, Research Triangle Park, North Carolina, USA.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.affiliation: Lata Medical Research Foundation, Nagpur, India.
authors.forename: Archana B
authors.initials: AB
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara / Q000453:epidemiology; D001208:Asia / Q000453:epidemiology; D001424:Bacterial Infections / Q000453:epidemiology* / Q000401:mortality; D001724:Birth Weight; D036861:Delivery, Obstetric / Q000379:methods / Q000639:trends; D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D007843:Latin America / Q000453:epidemiology; D008297:Male; D008423:Maternal Age; D011446:Prospective Studies; D012042:Registries; D012423:Rural Health / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Case fatality rates from neonatal sepsis; Global health; Incidence of neonatal sepsis; Low middle income countries; Neonatal sepsis; Possible severe bacterial infections