Aetiology of invasive bacterial infection and antimicrobial resistance in neonates in sub-Saharan Africa: a systematic review and meta-analysis in line with the STROBE-NI reporting guidelines
Open accessAbstract
BACKGROUND: Aetiological data for neonatal infections are essential to inform policies and programme strategies, but such data are scarce from sub-Saharan Africa. We therefore completed a systematic review and meta-analysis of available data from the African continent since 1980, with a focus on regional differences in aetiology and antimicrobial resistance (AMR) in the past decade (2008-18). METHODS: We included data for microbiologically confirmed invasive bacterial infection including meningitis and AMR among neonates in sub-Saharan Africa and assessed the quality of scientific reporting according to Strengthening the Reporting of Observational Studies in Epidemiology for Newborn Infection (STROBE-NI) checklist. We calculated pooled proportions for reported bacterial isolates and AMR. FINDINGS: We included 151 studies comprising data from 84 534 neonates from 26 countries, almost all of which were hospital-based. Of the 82 studies published between 2008 and 2018, insufficient details were reported regarding most STROBE-NI items. Regarding culture positive bacteraemia or sepsis, Staphylococcus aureus, Klebsiella spp, and Escherichia coli accounted for 25% (95% CI 21-29), 21% (16-27), and 10% (8-10) respectively. For meningitis, the predominant identified causes were group B streptococcus 25% (16-33), Streptococcus pneumoniae 17% (9-6), and S aureus 12% (3-25). Resistance to WHO recommended β-lactams was reported in 614 (68%) of 904 cases and resistance to aminoglycosides in 317 (27%) of 1176 cases. INTERPRETATION: Hospital-acquired neonatal infections and AMR are a major burden in Africa. More population-based neonatal infection studies and improved routine surveillance are needed to improve clinical care, plan health systems approaches, and address AMR. Future studies should be reported according to standardised reporting guidelines, such as STROBE-NI, to aid comparability and reduce research waste. FUNDING: Uduak Okomo was supported by a Medical Research Council PhD Studentship.
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The risk of antibiotic misuse is greater in paediatric populations due to lack of data on antibiotic dosing, lack of effective paediatric stewardship programmes and inability for effective diagnostics and culture and susceptibility testing.
“The risk of antibiotic misuse is greater in paediatric populations due to lack of data on antibiotic dosing in this population, lack of effective paediatric stewardship programmes and inability for effective diagnostics and culture and susceptibility testing in this population.12–14”
From Rationalizing irrational prescribing—infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India (2024) · cites this paper as [12]
The Discussion (page not provided) says sick newborns in many sub-Saharan African hospitals do not routinely receive microbiological investigations and calls for antimicrobial stewardship policies and improved diagnostics. It does not establish that antibiotic misuse is greater across paediatric populations than in other populations, or attribute that risk to a lack of dosing data or effective paediatric stewardship programmes. (LLM, conf=0.84)
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- Authors
- Okomo, U., Akpalu, E. N. K., Le Doare, K., Roca, A., Cousens, S., Jarde, A., Sharland, M., Kampmann, B., & Lawn, J. E.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Centre Hospitalier Universitaire de Tokoin (TG)
- MRC Unit the Gambia (GM)
- St George's, University of London (GB)
- Corresponding author
- Okomo, Uduak
- ORCID
- Venue
- The Lancet Infectious Diseases
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 19
- Issue
- 11
- Pages
- 1219-1234
- ISSN
- 1473-3099 (ISSN-L)
- OpenAlex
- W2972945544
- Cited by
- 321
- References
- 154
- Citations by year
- 2026: 39 · 2025: 56 · 2024: 56 · 2023: 46 · 2022: 41 · 2021: 61 · 2020: 20 · 2019: 2
- FWCI
- 5.07
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet Infectious Diseases (publishedVersion, public-domain)
- PubMed (publishedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Greater South Information System
- Funders
- Foundation for the National Institutes of Health
- Wellcome Trust
- Medical Research Council
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Neonatal and Maternal Infections
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Keywords
- antimicrobial resistance, neonatal sepsis, neonatal meningitis, bacteremia, Staphylococcus aureus, Klebsiella, Escherichia coli, Streptococcus agalactiae, Streptococcus pneumoniae, beta-lactam resistance, aminoglycoside resistance, sub-Saharan Africa, nosocomial infections
- MeSH terms
- Anti-Bacterial Agents, Bacteria, Female, Humans, Infant, Infant, Newborn, Male, Prevalence, Bacteremia, Meningitis, Bacterial, Africa South of the Sahara, Drug Resistance, Bacterial, Observational Studies as Topic
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