Economic case for a suppository intervention for treatment of neonatal sepsis in a community setting
|Ongoing since 2009
|Prof Nicholas J White FRS, Professor of Tropical Medicine at University Mahidol Thailand and University of Oxford
|Borislava Mihaylova and Bassel Tarbush, Research Assistant, Department of Economics
Neonatal sepsis is a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first four weeks of life. Antibiotics and supportive measures are usually given at hospital but often deaths from neonatal sepsis occur in the community; or soon after reaching a health facility. A proportion of deaths from neonatal sepsis may be preventable by early treatment with an antibiotic suppository as a pre-referral intervention.
The WHO estimated the burden of mortality for neonatal sepsis in 2004 (‘Global Burden of Disease’) based partly on work by Lawn et al. ‘4 million neonatal deaths; When? Where? Why?', The Lancet, vol. 365, no. 9462, 5 March 2005, p. 895. Neonatal infections (mainly sepsis and pneumonia and excluding diarrhoeal diseases) accounted for 26% of all neonatal deaths in 2004 (1 million deaths in total, based on 2000 mortality data). The absolute number of deaths from infections was highest in Southeast Asia, while the mortality rate in neonates from infections was highest in Sub-Saharan Africa. Alternatively, UNICEF (State of the World’s Children 2009) suggest that neonatal sepsis could account for up to 50% of all neonatal deaths.
The burden of severe neonatal sepsis is uncertain as data on incidence is limited. We plan to summarise the incidence of neonatal sepsis using review of various literature sources. We will evaluate more fully the burden of severe neonatal sepsis and mortality, ideally broken down by age and location (Sub-Saharan Africa vs. South and Southeast Asia), and will review likely access and use of health facilities and treatments. The clinical pathway for treatment of neonatal sepsis is likely to be similar to that for severe febrile illness, so we plan to adapt a framework developed in an earlier project. The development of the framework will depend on information from multiple literature searches to identify current pathways of management (or not) of severe sepsis, treatment effects, costs and health outcomes. Case studies for selected countries (to be decided) will be developed. A wide range of sensitivity analyses will explore the stability of results to certain parameters and possible future scenarios such as falling incidence of severe sepsis over time, improved access to treatments and other variables.