There was a modest excess risk
There was a modest excess risk of mortality associated with multidrug-resistant organisms, which was lower than that previously recorded in south Asia. There are methodological challenges in the attribution of excess neonatal mortality with antimicrobial resistance because of known confounding with severity of illness at presentation, treatment delay, and antibiotic choices. The fairly modest excess mortality (significant only for spp and spp) associated with antimicrobial resistance is also possibly accounted for by the high baseline mortality associated with culture-positive sepsis—as high as 67% in one facility.
Resistance among hospital acquired infections in Indian hospitals is a growing problem and driven by a combination of poor infection control and high, uncontrolled rates of antimicrobial prescribing. Many neonates in hospitals in south Asia are now treated with carbapenems as a first-line therapy for sepsis or presumed sepsis. Against this backdrop, the widespread availability and antimicrobial use in community settings and the contribution of antimicrobial resistance as a complicating factor in neonate sepsis becomes extremely important.
Notwithstanding the importance of preventive strategies to reduce the risks and burden of neonatal infections, early detection and prescribing of appropriate Actinomycin D will remain the cornerstone of management strategies. The DeNIS study highlights the serious risk associated with neonatal sepsis and resistance in health-care facilities that would rank among the better performing hospitals in a large middle-income country.
Although sporadic outbreaks continue to arise in west Africa, the recent Ebola virus disease (EVD) epidemic, which resulted in nearly 28 650 cases, has been contained. In Liberia specifically, the epidemic began in June, 2014, with the latest outbreak ending in January, 2016. Over 10 670 probable, suspected, and confirmed cases have been documented to date in the country. Individuals who survived EVD now face significant health challenges. Post-Ebola syndrome has been associated with uveitis, headache and other neurological symptoms, musculoskeletal pain, and insomnia, at least some of which are suspected to involve viral sequestration in body tissues and fluids. The medical issues of EVD survivors are often compounded by social stigmatisation due to fears of viral reactivation and potential transmission. Although pregnancy during acute EVD has been almost invariably associated with fetal loss, little is understood as to the antenatal courses and pregnancy outcomes in female EVD survivors who conceived after recovery.
Global health catastrophes have complex origins, often rooted in social disruption, poverty, conflict, and environmental collapse. Avoiding them will require a new integrative analysis of the links between disease, armed conflict, and environmental degradation within a socioecological vulnerability and human security context. Exploring these connections was the aim of , an expert workshop held in May 4–6, 2016, at Concordia University in Montreal, QC, Canada. The deliberate disruption of essential health services and conflict-related displacement has facilitated epidemics (eg, cholera in Zimbabwe, measles in the DR Congo, yellow fever in Angola, or polio in Somalia, Afghanistan, Pakistan, and Syria), interfered with vaccination campaigns, and posed immediate threats and long-term burdens to regional health security. Syria is currently facing an outbreak of cutaneous leishmaniasis as vector control programmes have been disrupted, and displaced persons experience poor housing, malnutrition, limited medical treatment options, and other susceptibility factors in refugee settlements. Declining or poor access to land, food, fuel, and safe water forces people, often women, to travel further for resources or shelter, eroding human and ecological resilience. The residual effects of recent civil wars in Sierra Leone and Liberia, including fragile health-care systems and deep distrust of governments, substantially hampered the capacity to respond to the Ebola virus disease crisis.