Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort study

IntroductionHeterogeneity in definitions of severe infection, sepsis and serious bacterial infection (SBI) in infants limits the comparability of randomised controlled trials (RCTs) of infection prevention interventions. To inform the design of infection prevention RCTs for infants in low-resource s...

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Vydané v:BMJ public health Ročník 3; číslo 2; s. e002383
Hlavní autori: Fung, Alastair, Heasley, Cole, Pell, Lisa G, Bassani, Diego G, Shah, Prakesh S, Morris, Shaun K, Hamer, Davidson, Islam, Mohammad Shahidul, Mahmud, Abdullah Al, Pullenayegum, Eleanor, Saha, Samir K, Haque, Rashidul, Hossain, Md Iqbal, Chen, Chun-Yuan, Emdin, Abby, O’Callaghan, Karen M, Loutet, Miranda G, Sultana, Shamima, Billah, S M Masum, Gaffar, S M Abdul, Karim, Enamul, Sayed, Sharika, Yeasmin, Sultana, Hoque, Md Mahbubul, Ahmed, Tahmeed, Sarker, Shafiqul A, Roth, Daniel E
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: England BMJ Publishing Group Ltd 13.07.2025
BMJ Publishing Group LTD
BMJ Publishing Group
Predmet:
Bacterial diseases
Blood
Caregivers
Disease Transmission, Infectious
Epidemiologic Research Design
Heterogeneity
Infants
Infections
Medical referrals
Mortality
Observational studies
Original Research
Prevalence
Public Health
Sepsis
Bangladesh
Dhaka Bangladesh
Epidemiologic Research Design
Public Health
Prevalence
Disease Transmission, Infectious
ISSN:2753-4294, 2753-4294
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Shrnutí:IntroductionHeterogeneity in definitions of severe infection, sepsis and serious bacterial infection (SBI) in infants limits the comparability of randomised controlled trials (RCTs) of infection prevention interventions. To inform the design of infection prevention RCTs for infants in low-resource settings, we estimated the incidence of severe infection and death among Bangladeshi infants aged 0–60 days using variations in case definitions.MethodsAmong 1939 infants born generally healthy in Dhaka, Bangladesh, severe infection was identified through up to 12 scheduled community health worker home visits from 0 to 60 days of age or through caregiver self-referral. The primary severe infection case definition combined physician documentation of standardised clinical signs and/or diagnosis of sepsis/SBI, plus either a positive blood culture or parenteral antibiotic treatment for ≥5 days. Incidence rates were estimated for the primary severe infection definition, the WHO definition of possible SBI, blood culture-confirmed infection and five alternative definitions including non-injury death.ResultsSevere infection incidence per 1000 infant-days was 1.2 (95% CI 0.97 to 1.4) using the primary definition, 0.84 (0.69 to 1.0) using the WHO definition of possible SBI, 0.026 (0.0085 to 0.081) using blood culture-confirmed infection and 0.061 (0.029 to 0.13) for death. One-third of cases met criteria for the primary severe infection definition through physician diagnosis of sepsis/SBI rather than the standardised clinical signs, and 85% of cases were identified following caregiver self-referral despite frequent scheduled visits.ConclusionsSevere infection incidence in infants varied considerably by case definition. Using a clinical sign-based definition may miss a substantial proportion of cases identified by physician diagnosis of sepsis/SBI. A consensus definition of severe infection in infants that balances permissiveness and stringency and can be operationalised in low-resource countries would improve the comparability of RCTs. If health facilities are accessible and caregivers readily seek care for infant illness, frequently scheduled home assessments may not be necessary.
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Additional supplemental material is published online only. To view, please visit the journal online (https://doi.org/10.1136/bmjph-2024-002383).
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
AF received consulting fees from Brigham and Women’s Hospital for separate work on the diagnostic accuracy of clinical sign algorithms to identify sepsis in young infants. None of the other authors had competing interests to declare.
ISSN:2753-4294
2753-4294
DOI:10.1136/bmjph-2024-002383