Department of Maternal, Neonatal, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland.
Department of Community Health, Kinshasa School of Public Health, Kinshasa, DR Congo.
PLoS One. 2021 Feb 24;16(2):e0247457. doi: 10.1371/journal.pone.0247457. eCollection 2021.
Community-based data on the prevalence of clinical signs of possible serious bacterial infection (PSBI) and the mortality associated with them are scarce. The aim was to examine the prevalence for each sign of infection and mortality associated with infants in the first two months of life, using community surveillance through community health workers (CHW).
We used population-based surveillance data of infants up to two months of age from the African Neonatal Sepsis Trial (AFRINEST). In this study, CHWs visited infants up to 10 times during the first two months of life at five sites in three sub-Saharan African countries. CHW assessed the infant for signs of infection (local or systemic) and referred infants who presented with any sign of infection to a health facility. We used a longitudinal analysis to calculate the risk of death associated with the presence of a sign of infection at the time of the visit until the subsequent visit.
During the first two months of their life, CHWs visited 84,759 live-born infants at least twice. In 11,089 infants (13.1%), one or more signs of infection were identified, of which 237 (2.1%) died. A sign of infection was detected at 2.1% of total visits. In 52% of visits, infants had one or more sign of systemic infection, while 25% had fast breathing in 7-59 days period and 23% had a local infection. All signs of infection, including multiple signs, were more frequently seen in the first week of life. The risk of mortality was very low (0.2%) for local infections and fast breathing in 7-59 days old, it was low for fast breathing 0-6 days old (0.6%), high body temperature (0.7%) and severe chest indrawing (1.0%), moderate for low body temperature (4.9%) and stopped feeding well/not able to feed at all (5.0%) and high for movement only when stimulated or no movement at all (10%) and multiple signs of systemic infection (15.5%). The risk of death associated with most clinical signs was higher (1.5 to 9 times) in the first week of life than at later age, except for low body temperature (4 times lower) as well as high body temperature (2 times lower).
Signs of infections are common in the first two months of life. The mortality risk differs with clinical signs and can be grouped as very low (local infections, fast breathing 7-59 days), low (fever, severe chest indrawing and fast breathing 0-6 days), moderate (low body temperature and stopped feeding well/not able to feed at all) and high (for movements only on stimulation or no movements at all and multiple signs of infection). New treatment strategies that consider differential mortality risk could be developed and evaluated based on these findings.
The trial was registered with Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.
社区层面关于可能严重细菌感染（PSBI）的临床体征以及与之相关的死亡率的资料较为匮乏。本研究旨在通过社区卫生工作者（CHW）进行社区监测，评估婴儿头两个月内每种感染体征的流行率以及与婴儿相关的死亡率。
我们使用了非洲新生儿败血症试验（AFRINEST）中年龄在两个月以内的婴儿的基于人群的监测数据。在这项研究中，CHW 在五个地点的头两个月内对五个撒哈拉以南非洲国家的婴儿进行了多达 10 次的访问。CHW 评估了婴儿的感染体征（局部或全身），并将出现任何感染体征的婴儿转介到医疗机构。我们使用纵向分析来计算在随访期间出现感染体征时直至下一次随访时与死亡相关的风险。
在头两个月的生命中，CHW 至少两次访问了 84759 名活产婴儿。在 11089 名婴儿（13.1%）中，发现了一种或多种感染体征，其中 237 名（2.1%）死亡。在总访视中有 2.1%出现了感染体征。在 52%的访视中，婴儿出现了一种或多种全身感染体征，而 25%的婴儿在 7-59 天期间出现呼吸急促，23%的婴儿出现局部感染。所有感染体征，包括多种体征，在生命的第一周更为常见。局部感染和 7-59 天龄呼吸急促的死亡率非常低（0.2%），0-6 天龄呼吸急促的死亡率较低（0.6%），体温升高（0.7%）和严重的胸部凹陷（1.0%），体温过低（4.9%）和停止进食良好/根本无法进食（5.0%）的死亡率为中度，只有刺激时才有运动或完全没有运动（10%）和多种全身感染体征（15.5%）的死亡率较高。与大多数临床体征相关的死亡风险在生命的第一周（1.5 到 9 倍）高于后期，除了体温过低（低 4 倍）和体温升高（低 2 倍）。
在头两个月的生命中，感染体征很常见。死亡率风险因临床体征而异，可以分为极低（局部感染、7-59 天呼吸急促）、低（发热、严重胸部凹陷和 0-6 天呼吸急促）、中度（体温过低和停止进食良好/根本无法进食）和高（只有刺激时才有运动或完全没有运动以及多种感染体征）。可以根据这些发现制定和评估新的考虑到差异死亡率风险的治疗策略。
该试验在澳大利亚和新西兰临床试验注册中心注册，ID 为 ACTRN 12610000286044。
