Developing world at superbug risk

Babies born in hospitals in the developing world are up to 20 times more likely to contract an infection than those in industrialised countries.

A review in The Lancet by researchers at the Aga Khan University in Pakistan said poor hygiene in labour wards and after birth was to blame. Up to 70% of neonatal infections are resistant to antibiotic treatment, they suggest. The researchers say fear of infection may deter people from using hospitals. Neonatal deaths account for over one-third of all child mortality across the world. Infections during pregnancy and after birth are estimated to kill 1.6 million babies in developing countries each year. Three-quarters of these deaths are in southern Asia and sub-Saharan Africa. The researchers say that evidence from studies in various countries which they examined suggested hospitals used unhygienic practices, increasing the risk of babies developing infections. In some cases, babies were forced to share three to a cot, and only one or two nurses were available to cover 60-bed wards. Deaths The team looked at 62 studies carried out in Asia, Africa and Latin America. It was found that rates of infections in the bloodstream contracted in hospital were up to 20 times higher than the rates of the maximum of five per 1,000 seen in industrialised countries. Large numbers of infections were caused by methicillin-resistant staphylococcus aureus (MRSA), which has caused so much concern in British hospitals. In South Asia, 56% of all staphylococcus aureus samples tested were resistant to the antibiotic methicyllin. Sources of MRSA included feeding tubes, catheters, incubators and mattresses. But the main vector for the spread of staphylococcus aureus infection was the hands of health-care providers, said the researchers. Another major threat was the organism Klebsiella pneumoniae, which caused an estimated 320,000 infant and unborn baby deaths each year in the developing world. ‘Wasted resources’ Writing in The Lancet, the team led by Dr Anita Zaidi, said they had seen dangerous practices such as disinfected respiratory tubing hanging over an open drain with urine and waste splashing on them, reconnection of intravenous infusion-system components that have fallen on heavily contaminated floors, and numerous lapses in hand-hygiene practice. They added: “These are probably routine and everyday occurrences in many, if not most, nurseries [in hospitals] in the poorest parts of the developing world. “Unfortunately, hospitals in developing countries are hotbeds of infection transmission, and expectations of improved neonatal outcome are being subverted by hospital-acquired infections and their associated morbidity, mortality and cost.” They said the infections could be put down to a lack of knowledge and training, together with an inadequate infrastructure and too few resources. The team said the high rates of infection meant that people who had been persuaded to attend hospital because they were told it would be better for them and their baby would be deterred from doing so – potentially cutting the infant’s chances of survival. They said: “When hospitals are seen as institutions where children experience poor outcomes at great cost, people in the communities in which they live are less likely to seek institutional care.” The researchers added: “Scarce resources are currently being wasted on flawed or ineffective care in developing countries. “Infection control in hospitals of developing countries must become part of the international agenda for health-systems improvement.” (Source: BBC Health, March 2005)