Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Nov;7(11):e009706.
doi: 10.1136/bmjgh-2022-009706.

Risk factors for community-acquired bacterial infection among young infants in South Asia: a longitudinal cohort study with nested case-control analysis

Nicholas E Connor  1   2 , Mohammad Shahidul Islam  3 , Luke C Mullany  4 , Nong Shang  5 , Zulfiqar A Bhutta  6   7 , Anita K M Zaidi  8 , Sajid Soofi  8 , Imran Nisar  8 , Pinaki Panigrahi  9 , Kalpana Panigrahi  10 , Radhanath Satpathy  10 , Anuradha Bose  11 , Rita Isaac  11 , Abdullah H Baqui  4 , Dipak K Mitra  12 , Qazi Sadeq-Ur Rahman  13 , Tanvir Hossain  13 , Stephanie J Schrag  5 , Jonas M Winchell  5 , Melissa L Arvay  5 , Maureen H Diaz  5 , Jessica L Waller  5 , Martin W Weber  14 , Davidson H Hamer  15   16 , Patricia Hibberd  15   16 , A S M Nawshad Uddin Ahmed  3 , Maksuda Islam  3 , Mohammad Belal Hossain  3 , Shamim A Qazi  17 , Shams El Arifeen  13 , Gary L Darmstadt  18 , Samir K Saha  3
Affiliations

Risk factors for community-acquired bacterial infection among young infants in South Asia: a longitudinal cohort study with nested case-control analysis

Nicholas E Connor et al. BMJ Glob Health. 2022 Nov.

Abstract

Objective: Risk factors predisposing infants to community-acquired bacterial infections during the first 2 months of life are poorly understood in South Asia. Identifying risk factors for infection could lead to improved preventive measures and antibiotic stewardship.

Methods: Five sites in Bangladesh, India and Pakistan enrolled mother-child pairs via population-based pregnancy surveillance by community health workers. Medical, sociodemographic and epidemiological risk factor data were collected. Young infants aged 0-59 days with signs of possible serious bacterial infection (pSBI) and age-matched controls provided blood and respiratory specimens that were analysed by blood culture and real-time PCR. These tests were used to build a Bayesian partial latent class model (PLCM) capable of attributing the probable cause of each infant's infection in the ANISA study. The collected risk factors from all mother-child pairs were classified and analysed against the PLCM using bivariate and stepwise logistic multivariable regression modelling to determine risk factors of probable bacterial infection.

Results: Among 63 114 infants born, 14 655 were assessed and 6022 had signs of pSBI; of these, 81% (4859) provided blood samples for culture, 71% (4216) provided blood samples for quantitative PCR (qPCR) and 86% (5209) provided respiratory qPCR samples. Risk factors associated with bacterial-attributed infections included: low (relative risk (RR) 1.73, 95% credible interval (CrI) 1.42 to 2.11) and very low birth weight (RR 5.77, 95% CrI 3.73 to 8.94), male sex (RR 1.27, 95% CrI 1.07 to 1.52), breathing problems at birth (RR 2.50, 95% CrI 1.96 to 3.18), premature rupture of membranes (PROMs) (RR 1.27, 95% CrI 1.03 to 1.58) and being in the lowest three socioeconomic status quintiles (first RR 1.52, 95% CrI 1.07 to 2.16; second RR 1.41, 95% CrI 1.00 to 1.97; third RR 1.42, 95% CrI 1.01 to 1.99).

Conclusion: Distinct risk factors: birth weight, male sex, breathing problems at birth and PROM were significantly associated with the development of bacterial sepsis across South Asian community settings, supporting refined clinical discernment and targeted use of antimicrobials.

Keywords: child health; cohort study; infections, diseases, disorders, injuries; paediatrics.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Characteristics of the infants enrolled and analysed in the ANISA study. ANISA, Aetiology of Neonatal Infection in South Asia; CHWs, community health workers; pSBI, possible serious bacterial infection; TAC, TaqMan® Array Card
See this image and copyright information in PMC

References

    1. GBD 2016 Causes of Death Collaborators . Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the global burden of disease study 2016. Lancet 2017;390:1151–210. 10.1016/S0140-6736(17)32152-9 - DOI - PMC - PubMed
    1. Saha SK, Schrag SJ, El Arifeen S, et al. . Causes and incidence of community-acquired serious infections among young children in South Asia (ANISA): an observational cohort study. Lancet 2018;392:145–59. 10.1016/S0140-6736(18)31127-9 - DOI - PMC - PubMed
    1. Sharrow D, Hug L, Liu Y. Levels & trends in child mortality report 2020. Estimates developed by the UN inter-agency group for child mortality estimation. United Nations Inter-Agency Group for Child Mortality Estimation (UNIGME), 2020.
    1. Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, et al. . The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med 2018;6:223–30. 10.1016/S2213-2600(18)30063-8 - DOI - PubMed
    1. Kissoon N, Uyeki TM. Sepsis and the global burden of disease in children. JAMA Pediatr 2016;170:107–8. 10.1001/jamapediatrics.2015.3241 - DOI - PMC - PubMed

Publication types