CAN WE MANAGE NEONATAL INFECTION IN THE COMMUNITY ?

As infant mortality rates have fallen in many developing countries, the problem of neonatal mortality has become more obvious. The biggest causes of mortality in the first month of life are infection, birth asphyxia, and low birth weight. Infection is implicated in about a third of neonatal deaths in Nepal. Communitybased data are limited, but neonatal sepsis is likely to be the result of infection by Gram positive bacteria such as Staphylococci and Streptococci, and enteric Gram negatives. The appropriate management for neonatal sepsis is parenteral, hospital-based treatment with a penicillin and an aminoglycoside. However, about 90% of births in Nepal take place at home, and many infants never reach hospital. For these infants, the next best management strategy is to give parenteral antibiotics at a primary care facility. Before referral, it would be appropriate to give a dose of oral antibiotic such as cotrimoxazole, which is already incorporated into the acute respiratory infection programme. If referral for parenteral treatment is not successful, we propose that community-based cadres be allowed to give a full course of oral antibiotic in cases of neonatal sepsis. Community health workers should receive training and pictorial guidelines for the recognition of danger signs for neonatal sepsis, and we recommend pilot studies to compare and evaluate oral treatment in the community. For Nepal, a national policy on the community management of neonatal infection is an extremely urgent priority. Key Words: Neonatal infection, community management, antibiotic use