Newborn mortality rates remain high, despite global efforts to reduce deaths in children aged younger than 5 years. According to UNICEF, in 2019, newborn babies accounted for almost half of all deaths in young children, with an estimated 6,700 newborn deaths recorded daily. Moreover, 42% of deaths occurred in sub-Saharan Africa and infections were a major cause of these deaths.

The Baby GERMS-SA team, led by experts from the National Institute for Communicable Diseases, a division of the National Health Laboratory Service, conducted a six-year study to estimate the burden of culture-confirmed neonatal bloodstream infections and meningitis in South Africa. Funded by the Bill and Melinda Gates Foundation, the study involved an analysis of blood and cerebrospinal fluid culture pathology records from newborn babies at 256 public-sector hospitals. The study revealed that most infections occurred after day 3 of life and thus were probably acquired in hospital and that a large proportion of infections were caused by multi-drug-resistant bacteria.

This is the first national population-level analysis of invasive newborn infections in the local public health sector and involved babies younger than 28-days who were admitted between January 2014 and December 2019. Almost 38 000 cases of infection were diagnosed over the 6-year period. The average age of babies at the time of diagnosis of infection was 7-days. Around 70% of cases were caused by three bacterial pathogens, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus, none of which can be prevented by vaccines and a large proportion of which were resistant to antibiotics usually used to treat neonatal infections. Two-thirds of cases were diagnosed in hospitals in Gauteng and KwaZulu-Natal provinces.

There was an increase in the national annual incidence risk over the study period; this is a measure of new cases of invasive neonatal infections as a proportion of annual registered live births. Almost half of neonatal cases of infection were diagnosed at regional hospitals. The incidence risk of late-onset infections (which were probably acquired in hospital) was considerably higher than reported in resource-rich countries.

In conclusion, the study addresses a crucial knowledge gap and these burden estimates will serve as a baseline to measure the impact of future interventions in South Africa. Moreover, the study authors point out that infection prevention and control measures need to be strengthened, together with antimicrobial stewardship programmes in neonatal units. And finally, the importance of distributing resources appropriately across the various tiers of public sector health facilities is emphasised.

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