EVALUATION OF NATIONAL PROTOCOLS FOR MANAGING SEVERE BACTERIAL INFECTIONS IN NEWBORNS: A REVIEW OF 90 ENAP COUNTRIES

Abstract

Background: In 2020, the WHO released the Standards for improving the quality of care for small and sick newborns in health facilities (SSNC), which includes Standard 1.12, specifically focused on neonatal infection management. This standard supports the progress towards the 2023 Sustainable Development Goal 3.2, with the aim of reducing neonatal mortality to fewer than 12 deaths per 1,000 live births. The Every Newborn Action Plan (ENAP), developed and adopted by 90 countries in 2014, provides a framework for achieving this goal.
Method: A systematic literature search was conducted to identify published research on neonatal infection management in the 90 ENAP countries using keywords derived from SSNC Quality statement 1.12. In addition, publicly available national protocols were compiled. Key components were evaluated against WHO standard 1.12, including national availability, antibiotics mentioned, dosages, first- and second-line antibiotics, signs of sepsis, and blood cultures.
Results: Out of 622 publications, 53 were selected for in-depth analysis, focusing on 23 of the 90 ENAP countries. This study provides a comprehensive review of neonatal infection research from these 23 countries, 18 of which have publicly available national protocols. National protocols were accessible for 30 out of 90 countries (33.3%). Among these, 28 (93.3%) addressed clinical symptom assessment at admission, and 29 (96.7%) specified antibiotic use, with 22 (73.3%) detailing dosages. Blood culture collection was mentioned in 19 (63.3%) protocols. However, only 13 (43.3%) countries fully incorporated all components of WHO standard 1.12, revealing significant gaps in neonatal infection management protocols across ENAP countries.
Conclusion: Addressing the identified gaps and improving the availability of publicly accessible national protocols can enhance healthcare delivery, transparency, and accountability. However, significant gaps remain in their implementation across ENAP countries