ArticleBMC pregnancy and childbirth2015
Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions.
Article in BMC pregnancy and childbirth, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- Investigating the implementation of infection prevention and control practices in neonatal care across country income levels: a systematic review.Antimicrobial resistance and infection control · 2025Pooled it
- Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review.Implementation science : IS · 2018Pooled it
- Neonatal Bloodstream Infections: A Narrative Review on Diagnostic and Therapeutic Challenges and Prospects in Developing Countries.Health science reports · 2026Article
- Cord care practices and related outcomes among caregivers in two referral facilities in Ghana: a cross-sectional study.BMC pediatrics · 2025Article
- Bottlenecks Analysis in the Intervention of Improving Maternal Health in Rural Areas of Tanzania: A Convergent Mixed-Method Approach.International journal of health policy and management · 2025Article
- Limitations of current techniques in clinical antimicrobial resistance diagnosis: examples and future prospects.npj antimicrobials and resistance · 2024Review
- Article
- Antibiotic use for inpatient newborn care with suspected infection: EN-BIRTH multi-country validation study.BMC pregnancy and childbirth · 2021Observational
- Clinical signs of possible serious infection and associated mortality among young infants presenting at first-level health facilities.PloS one · 2021Article
- Simplified Dosing Regimens for Gentamicin in Neonatal Sepsis.Frontiers in pharmacology · 2021Article
- Geographical accessibility in assessing bypassing behaviour for inpatient neonatal care, Bungoma County-Kenya.BMC pregnancy and childbirth · 2020Article
- Understanding key drivers and barriers to implementation of the WHO recommendations for the case management of childhood pneumonia and possible serious bacterial infection with amoxicillin dispersible tablets (DT) in Bangladesh: a qualitative study.BMC health services research · 2020Article
- Provider performance and facility readiness for managing infections in young infants in primary care facilities in rural Bangladesh.PloS one · 2020Article
- Article
- Review
- Combining bottleneck analysis and quality improvement as a novel methodology to improve the quality of neonatal care in a northeastern state of India: a feasibility study.International health · 2019Article
- Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh.BMJ global health · 2019Review
- Developing recommendations for neonatal inpatient care service categories: reflections from the research, policy and practice interface in Kenya.BMJ global health · 2019Article
- Understanding health systems to improve community and facility level newborn care among displaced populations in South Sudan: a mixed methods case study.BMC pregnancy and childbirth · 2018Article
- Article
Corrections and comments
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Authors and funding
11 authors at 7 institutions in 3 countries.
Funding
Abstract
backgroundAround one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity.
methodsA standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections.
resultsFor neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges.
conclusionsRapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups.
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