Significant improvements in child survival rates have contributed to the overall worldly gains in life expectancy during the past two decades. In 1990-2012 , the neonatal mortality decreased from 36 to 19 deaths per 1000 livebirths but it lagged behind the postneonatal under—5 years mortality.
In the August online issue of “The Lancet Global Health”, the editor discusses the reasons why almost half of the newborn mortality occurs around the time of birth, for which interventions must focus in this period. Neonatal sepsis or meningitis accounts for 421, 000 or 16% of the total tally.
In the Republic of India—where there has been a remarkable improvement of the equity and quality of primary health care facilities for the population at large in the past two decades—there are still 56,524 neonatal deaths per year due to resistance of the gram negative bacteria to first line antibiotics.
The Delhi Neonatal Infection Study (DeNIS) followed a cohort of 88,636 newborn infants treated in three large New Delhi hospitals for three years. The rate of improvement in the treatment of culture positive—neonatal sepsis was 9.5 per 1000 livebirths compared to 15.6 for the rest of India. Two thirds of he sepsis cases occurred within 72 hours of birth and the most common agents were Klebsiella spp, Acinetobacter spp and Escherichia coli.
The significant neonatal mortality in South Asia could also be related to the severity of the initial presentation and the treatment delay in rural areas. Paradoxically the increased availability of antibiotics in primary care centers and their indiscriminate use by medical practitioners to treat ailments could have sparked the surge of resistant organisms in closed-knit communities.
As there has been a concerted effort by international health organisations to move the birth process away from the inadequate home settings to the better equipped hospitals and clinics in low and middle income countries like India, the infection control services must get more economic and human resources.
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