CAN WE MANAGE NEONATAL INFECTION IN THE COMMUNITY ?

As infant mortality rates have fallen in many developing countries, the problem of neonatal mortality hasbecome 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. Communitybaseddata are limited, but neonatal sepsis is likely to be the result of infection by Gram positive bacteriasuch as Staphylococci and Streptococci, and enteric Gram negatives.The appropriate management for neonatal sepsis is parenteral, hospital-based treatment with a penicillinand an aminoglycoside. However, about 90% of births in Nepal take place at home, and many infants neverreach hospital. For these infants, the next best management strategy is to give parenteral antibiotics at aprimary care facility. Before referral, it would be appropriate to give a dose of oral antibiotic such ascotrimoxazole, which is already incorporated into the acute respiratory infection programme. If referralfor parenteral treatment is not successful, we propose that community-based cadres be allowed to give a fullcourse of oral antibiotic in cases of neonatal sepsis.Community health workers should receive training and pictorial guidelines for the recognition of dangersigns for neonatal sepsis, and we recommend pilot studies to compare and evaluate oral treatment in thecommunity. For Nepal, a national policy on the community management of neonatal infection is an extremelyurgent priority.Key Words: Neonatal infection, community management, antibiotic use.