Reducing neonatal mortality in Africa and South Asia

Antimicrobial resistance (AMR) has recently been identified as one of the most serious threats to public health, food security and development across the globe, with levels of resistance rising dangerously high.

Misuse of antibiotics, globalisation, and other society related practices are key drivers behind the ever-increasing AMR threat. Numerous causes contribute to the misuse of antibiotics globally: over-the-counter sales and uncontrolled use in low-middle income countries (LMICs); incomplete courses of antibiotics; inadequate medical prescriptions, low healthcare expenditures and lack of knowledge.

Globalisation, triggered by the continuous movement of people over international borders, provides the opportunity for resistant bacteria to spread from one geographic location to another, fomenting the rise of AMR. Society idiosyncrasies and behaviour, including poor hygiene, overcrowding, low health care expenditures, use of antibiotics in agriculture, animal husbandry, aquaculture and veterinary medicine, and the release of antibiotics into the environment, all contribute to this hazard.

These serious concerns have been catalysed by the rapid increase and spread of multi-drug Resistant (MDR) Gram-negative bacteria (GNB) that render infections increasingly difficult to treat.

Developing countries bear the burden of 99% of neonatal mortality worldwide with infections such as tetanus, pneumonia and sepsis acting as leading causes of neonatal mortality.

BARNARDS which stands for ‘Burden of Antibiotic Resistance in Neonates from Developing Societies’ is a project that aims are to investigate the effects of antibiotic resistance on neonatal morbidity and mortality in LMICs and identify possible solutions to minimise the impacts, particularly in regard to neonatal sepsis in babies who are less than 60 days old.

BARNARDS is funded by the Bill & Melinda Gates Foundation and to date has established a network of neonatal centres within Nigeria, Bangladesh, Rwanda, South Africa, Pakistan, Ethiopia and India. Local teams enrol all mothers in labour presenting to hospital or centres who give consent.

Patient socio-demographic data is collected and rectal swabs are taken from enrolled mothers. The control group includes mothers with healthy babies. Babies who present with signs of infection <7 days (early onset of sepsis) and those who return to the hospital >7 - <60 days (late onset sepsis) compose the study cases.

Samples are also taken from the hospital environment at each centre, including medical devices, bed linen, door handles, taps, etc., constituting the environmental fraction of the study.