ArticleBMC pediatrics2023
Blood culture versus antibiotic use for neonatal inpatients in 61 hospitals implementing with the NEST360 Alliance in Kenya, Malawi, Nigeria, and Tanzania: a cross-sectional study.
Article in BMC pediatrics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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12 citing papers in PubMed, 21 citations in OpenAlex.
- Co-design of the Implementation Toolkit for Small and Sick Newborn Care: a global open-access knowledge management web platform and linked community targeting the know-do gap.BMC pediatrics · 2026Article
- Nanomotion-enabled ultra-rapid antibiotic susceptibility testing with magnetic bead-based pathogen enrichment for accelerated sepsis diagnostics.Scientific reports · 2026Article
- Are hospital management practices associated with enhanced quality of care for small and sick newborns? A nationwide cross-sectional study using linked inpatient admission records in Malawi.Journal of global health · 2026Article
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- Parental involvement in infection prevention and control in low- and middle-income country neonatal units: a scoping review.Antimicrobial resistance and infection control · 2025Article
- Born Too Soon: Care for small and sick newborns, evidence for investment and implementation.Reproductive health · 2025Article
- Parental involvement in infection prevention and control in low- and middle-income country neonatal units: a scoping review protocol.BMJ open · 2025Article
- Situational analysis of antibiotic prescriptions in Kenyan neonatal units for antimicrobial stewardship: a retrospective longitudinal study.EClinicalMedicine · 2025Article
- A study protocol for neonatal sepsis and gut microbiomics among preterm infants admitted at Muhimbili National Hospital, Tanzania.PloS one · 2025Article
- Phenotypic markers misclassify isolates of Salmonella Typhimurium as S. Typhi, but were correctly identified by whole genome sequencing during a septicemia study in western Kenya.PLOS global public health · 2025Article
- Multicentre external validation of the Neonatal Healthcare-associated infectiOn Prediction (NeoHoP) score: a retrospective case-control study.BMJ paediatrics open · 2024Observational
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Authors and funding
17 authors at 8 institutions in 6 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThirty million small and sick newborns worldwide require inpatient care each year. Many receive antibiotics for clinically diagnosed infections without blood cultures, the current 'gold standard' for neonatal infection detection. Low neonatal blood culture use hampers appropriate antibiotic use, fuelling antimicrobial resistance (AMR) which threatens newborn survival. This study analysed the gap between blood culture use and antibiotic prescribing in hospitals implementing with Newborn Essential Solutions and Technologies (NEST360) in Kenya, Malawi, Nigeria, and Tanzania.
methodsInpatient data from every newborn admission record (July 2019-August 2022) were included to describe hospital-level blood culture use and antibiotic prescription. Health Facility Assessment data informed performance categorisation of hospitals into four tiers: (Tier 1) no laboratory, (Tier 2) laboratory but no microbiology, (Tier 3) neonatal blood culture use < 50% of newborns receiving antibiotics, and (Tier 4) neonatal blood culture use > 50%.
resultsA total of 144,146 newborn records from 61 hospitals were analysed. Mean hospital antibiotic prescription was 70% (range = 25-100%), with 6% mean blood culture use (range = 0-56%). Of the 10,575 blood cultures performed, only 24% (95%CI 23-25) had results, with 10% (10-11) positivity. Overall, 40% (24/61) of hospitals performed no blood cultures for newborns. No hospitals were categorised as Tier 1 because all had laboratories. Of Tier 2 hospitals, 87% (20/23) were District hospitals. Most hospitals could do blood cultures (38/61), yet the majority were categorised as Tier 3 (36/61). Only two hospitals performed > 50% blood cultures for newborns on antibiotics (Tier 4).
conclusionsThe two Tier 4 hospitals, with higher use of blood cultures for newborns, underline potential for higher blood culture coverage in other similar hospitals. Understanding why these hospitals are positive outliers requires more research into local barriers and enablers to performing blood cultures. Tier 3 facilities are missing opportunities for infection detection, and quality improvement strategies in neonatal units could increase coverage rapidly. Tier 2 facilities could close coverage gaps, but further laboratory strengthening is required. Closing this culture gap is doable and a priority for advancing locally-driven antibiotic stewardship programmes, preventing AMR, and reducing infection-related newborn deaths.
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