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Effect of case management on neonatal mortality due to sepsis and pneumonia.

ABSTRACT: BACKGROUND: Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST). METHODS: We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where appropriate. For interventions with biological plausibility but low quality evidence, a Delphi process was undertaken to estimate effectiveness. RESULTS: Searches of 2876 titles identified 7 studies. Among these, 4 evaluated oral antibiotics for neonatal pneumonia in non-randomised, concurrently controlled designs. Meta-analysis suggested reductions in all-cause neonatal mortality (RR 0.75 95% CI 0.64- 0.89; 4 studies) and neonatal pneumonia-specific mortality (RR 0.58 95% CI 0.41- 0.82; 3 studies). Two studies (1 RCT, 1 observational study), evaluated community-based neonatal care packages including injectable antibiotics and reported mortality reductions of 44% (RR = 0.56, 95% CI 0.41-0.77) and 34% (RR = 0.66, 95% CI 0.47-0.93), but the interpretation of these results is complicated by co-interventions. A third, clinic-based, study reported a case-fatality ratio of 3.3% among neonates treated with injectable antibiotics as outpatients. No studies were identified evaluating injectable antibiotics alone for neonatal pneumonia. Delphi consensus (median from 20 respondents) effects on sepsis-specific mortality were 30% reduction for oral antibiotics, 65% for injectable antibiotics and 75% for injectable antibiotics on pneumonia-specific mortality. No trials were identified assessing effect of hospital management for neonatal infections and Delphi consensus suggested 80%, and 90% reductions for sepsis and pneumonia-specific mortality respectively. CONCLUSION: Oral antibiotics administered in the community are effective for neonatal pneumonia mortality reduction based on a meta-analysis, but expert opinion suggests much higher impact from injectable antibiotics in the community or primary care level and even higher for facility-based care. Despite feasibility and low cost, these interventions are not widely available in many low income countries. FUNDING: This work was supported by the Bill & Melinda Gates Foundation through a grant to the US Fund for UNICEF, and to Saving Newborn Lives Save the Children, through Save the Children US.

SUBMITTER: Zaidi AK

PROVIDER: S-EPMC3231886 | biostudies-other | 2011

REPOSITORIES: biostudies-other

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Effect of case management on neonatal mortality due to sepsis and pneumonia.

Zaidi Anita K M AK Ganatra Hammad A HA Syed Sana S Cousens Simon S Lee Anne C C AC Black Robert R Bhutta Zulfiqar A ZA Lawn Joy E JE

BMC public health 20110413

<h4>Background</h4>Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST).<h4>Methods</h4>We conducted systematic search ...[more]

PMID: 21501430

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Project description:BACKGROUND:With the aim of populating the Lives Saved Tool (LiST) with parameters of effectiveness of existing interventions, we conducted a systematic review of the literature assessing the effect of pneumonia case management on mortality from childhood pneumonia. METHODS:This review covered the following interventions: community case management with antibiotic treatment, and hospital treatment with antibiotics, oxygen, zinc and vitamin A. Pneumonia mortality outcomes were sought where available but data were also recorded on secondary outcomes. We summarized results from randomized controlled trials (RCTs), cluster RCTs, quasi-experimental studies and observational studies across outcome measures using standard meta-analysis methods and used a set of standardized rules developed for the purpose of populating the LiST with required parameters, which dealt with the issues of comparability of the studies in a uniform way across a spectrum of childhood conditions. RESULTS:We estimate that community case management of pneumonia could result in a 70% reduction in mortality from pneumonia in 0-5-year-old children. In contrast treatment of pneumonia episodes with zinc and vitamin A is ineffective in reducing pneumonia mortality. There is insufficient evidence to make a quantitative estimate of the effect of hospital case management on pneumonia mortality based on the published data. CONCLUSION:The available evidence reinforces the effectiveness of community and hospital case management with World Health Organization-recommended antibiotics and the lack of effect of zinc and vitamin A supportive treatment for children with pneumonia. Evidence from one trial demonstrates the effectiveness of oxygen therapy but further research is required to give higher quality evidence so that an effect estimate can be incorporated into the LiST model. We identified no trials that separately evaluated the effectiveness of other supportive care interventions. The summary estimates of effect on pneumonia mortality will inform the LiST model.

Project description:IntroductionIndia contributes to the highest number of neonatal deaths globally. It also has the greatest number of pneumonia-related neonatal deaths in the developing world. We aim to systematically review the evidence for the factors associated with mortality due to neonatal pneumonia in the Indian context, to address the lack of consolidated evidence on this important issue.Methods and analysisThis protocol is part of a series of three reviews on neonatal pneumonia in India. Observational studies reporting on outcome of neonatal pneumonia in the Indian context, and published in English in peer-reviewed and indexed journals will be eligible for inclusion. Outcomes of this review will be the factors determining mortality due to neonatal pneumonia. A total of nine databases will be searched. Electronic and hand searching of published and grey literature will be performed. Selection of studies will be done in title, abstract and full text screening stages. Risk of bias, independently assessed by two authors, will be evaluated. Meta-analysis will be performed and heterogeneity assessed. Pooled effect estimates will be stated with 95% confidence intervals. Narrative synthesis will be done where meta-analysis cannot be performed. Publication bias will be evaluated and sensitivity analysis performed according to study quality. Quality of this review will be evaluated using AMSTAR (Assessing the Methodological quality of Systematic Reviews) and GRADE (Grades of Recommendation, Assessment, Development & Evaluation). A summary of findings table will be reported using GRADEPro.Ethics and disseminationSince this is a review involving analysis of secondary data which is available in the public domain, and does not involve human participants, ethical approval was not required. The findings of the study will be shared with all stakeholders of this research. Knowledge dissemination workshops will be conducted with relevant stakeholders to transfer the evidence, tailored to the stakeholder (eg, policy briefs, publications, information booklets, etc).

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Effect of case management on neonatal mortality due to sepsis and pneumonia.

Publications

Effect of case management on neonatal mortality due to sepsis and pneumonia.

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