Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort study
Introduction Heterogeneity in definitions of severe infection, sepsis and serious bacterial infection (SBI) in infants limits the comparability of randomised controlled trials (RCTs) of infection prevention interventions. To inform the design of infection prevention RCTs for infants in low-resource...
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BMJ Publishing Group
2025-07-01
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| author | Rashidul Haque Tahmeed Ahmed Samir K Saha Lisa G Pell Diego G Bassani Shaun K Morris Prakesh S Shah Mohammad Shahidul Islam Alastair Fung Daniel E Roth Md Iqbal Hossain Eleanor Pullenayegum Davidson Hamer Miranda G Loutet Abdullah Al Mahmud Cole Heasley Chun-Yuan Chen Abby Emdin Karen M O’Callaghan Shamima Sultana S M Masum Billah S M Abdul Gaffar Enamul Karim Sharika Sayed Sultana Yeasmin Md Mahbubul Hoque Shafiqul A Sarker |
| author_facet | Rashidul Haque Tahmeed Ahmed Samir K Saha Lisa G Pell Diego G Bassani Shaun K Morris Prakesh S Shah Mohammad Shahidul Islam Alastair Fung Daniel E Roth Md Iqbal Hossain Eleanor Pullenayegum Davidson Hamer Miranda G Loutet Abdullah Al Mahmud Cole Heasley Chun-Yuan Chen Abby Emdin Karen M O’Callaghan Shamima Sultana S M Masum Billah S M Abdul Gaffar Enamul Karim Sharika Sayed Sultana Yeasmin Md Mahbubul Hoque Shafiqul A Sarker |
| author_sort | Rashidul Haque |
| collection | DOAJ |
| description | Introduction Heterogeneity in definitions of severe infection, sepsis and serious bacterial infection (SBI) in infants limits the comparability of randomised controlled trials (RCTs) of infection prevention interventions. To inform the design of infection prevention RCTs for infants in low-resource settings, we estimated the incidence of severe infection and death among Bangladeshi infants aged 0–60 days using variations in case definitions.Methods Among 1939 infants born generally healthy in Dhaka, Bangladesh, severe infection was identified through up to 12 scheduled community health worker home visits from 0 to 60 days of age or through caregiver self-referral. The primary severe infection case definition combined physician documentation of standardised clinical signs and/or diagnosis of sepsis/SBI, plus either a positive blood culture or parenteral antibiotic treatment for ≥5 days. Incidence rates were estimated for the primary severe infection definition, the WHO definition of possible SBI, blood culture-confirmed infection and five alternative definitions including non-injury death.Results Severe infection incidence per 1000 infant-days was 1.2 (95% CI 0.97 to 1.4) using the primary definition, 0.84 (0.69 to 1.0) using the WHO definition of possible SBI, 0.026 (0.0085 to 0.081) using blood culture-confirmed infection and 0.061 (0.029 to 0.13) for death. One-third of cases met criteria for the primary severe infection definition through physician diagnosis of sepsis/SBI rather than the standardised clinical signs, and 85% of cases were identified following caregiver self-referral despite frequent scheduled visits.Conclusions Severe infection incidence in infants varied considerably by case definition. Using a clinical sign-based definition may miss a substantial proportion of cases identified by physician diagnosis of sepsis/SBI. A consensus definition of severe infection in infants that balances permissiveness and stringency and can be operationalised in low-resource countries would improve the comparability of RCTs. If health facilities are accessible and caregivers readily seek care for infant illness, frequently scheduled home assessments may not be necessary. |
| format | Article |
| id | doaj-art-f394bc85f48c4a9fbe22493b1da99ee9 |
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| language | English |
| publishDate | 2025-07-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-f394bc85f48c4a9fbe22493b1da99ee92025-07-14T04:40:13ZengBMJ Publishing GroupBMJ Public Health2753-42942025-07-013210.1136/bmjph-2024-002383Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort studyRashidul Haque0Tahmeed Ahmed1Samir K Saha2Lisa G Pell3Diego G Bassani4Shaun K Morris5Prakesh S Shah6Mohammad Shahidul Islam7Alastair Fung8Daniel E Roth9Md Iqbal Hossain10Eleanor Pullenayegum11Davidson Hamer12Miranda G Loutet13Abdullah Al Mahmud14Cole Heasley15Chun-Yuan Chen16Abby Emdin17Karen M O’Callaghan18Shamima Sultana19S M Masum Billah20S M Abdul Gaffar21Enamul Karim22Sharika Sayed23Sultana Yeasmin24Md Mahbubul Hoque25Shafiqul A Sarker2612 Centre for Vaccine Sciences, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh8 Clinical Sciences Division (CSD); Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh4 Child Health Research Foundation, Dhaka, BangladeshChild Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada1 Centre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, CanadaCentre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, CanadaDepartment of Paediatrics, University of Toronto, Toronto, ON, CanadaChild Health Research Foundation, Dhaka, BangladeshPediatrics and Child Health, Winnipeg Children`s Hospital, Winnipeg, Manitoba, CanadaDalla Lana School of Public Health, Toronto, Ontario, CanadaInternational Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshHospital for Sick Children, University of Toronto, Toronto, Ontario, CanadaDepartment of Global Health, Boston University, Boston, Massachusetts, USADalla Lana School of Public Health, University of Toronto, Toronto, Ontario, CanadaInternational Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshCentre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, CanadaCentre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, CanadaUniversity of Toronto Dalla Lana School of Public Health, Toronto, Ontario, CanadaDepartment of Nutritional Sciences, King’s College London, London, UKInternational Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshInternational Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshInternational Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshInternational Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshInternational Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshInternational Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshBangladesh Shishu Hospital and Institute, Dhaka, BangladeshInternational Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshIntroduction Heterogeneity in definitions of severe infection, sepsis and serious bacterial infection (SBI) in infants limits the comparability of randomised controlled trials (RCTs) of infection prevention interventions. To inform the design of infection prevention RCTs for infants in low-resource settings, we estimated the incidence of severe infection and death among Bangladeshi infants aged 0–60 days using variations in case definitions.Methods Among 1939 infants born generally healthy in Dhaka, Bangladesh, severe infection was identified through up to 12 scheduled community health worker home visits from 0 to 60 days of age or through caregiver self-referral. The primary severe infection case definition combined physician documentation of standardised clinical signs and/or diagnosis of sepsis/SBI, plus either a positive blood culture or parenteral antibiotic treatment for ≥5 days. Incidence rates were estimated for the primary severe infection definition, the WHO definition of possible SBI, blood culture-confirmed infection and five alternative definitions including non-injury death.Results Severe infection incidence per 1000 infant-days was 1.2 (95% CI 0.97 to 1.4) using the primary definition, 0.84 (0.69 to 1.0) using the WHO definition of possible SBI, 0.026 (0.0085 to 0.081) using blood culture-confirmed infection and 0.061 (0.029 to 0.13) for death. One-third of cases met criteria for the primary severe infection definition through physician diagnosis of sepsis/SBI rather than the standardised clinical signs, and 85% of cases were identified following caregiver self-referral despite frequent scheduled visits.Conclusions Severe infection incidence in infants varied considerably by case definition. Using a clinical sign-based definition may miss a substantial proportion of cases identified by physician diagnosis of sepsis/SBI. A consensus definition of severe infection in infants that balances permissiveness and stringency and can be operationalised in low-resource countries would improve the comparability of RCTs. If health facilities are accessible and caregivers readily seek care for infant illness, frequently scheduled home assessments may not be necessary.https://bmjpublichealth.bmj.com/content/3/2/e002383.full |
| spellingShingle | Rashidul Haque Tahmeed Ahmed Samir K Saha Lisa G Pell Diego G Bassani Shaun K Morris Prakesh S Shah Mohammad Shahidul Islam Alastair Fung Daniel E Roth Md Iqbal Hossain Eleanor Pullenayegum Davidson Hamer Miranda G Loutet Abdullah Al Mahmud Cole Heasley Chun-Yuan Chen Abby Emdin Karen M O’Callaghan Shamima Sultana S M Masum Billah S M Abdul Gaffar Enamul Karim Sharika Sayed Sultana Yeasmin Md Mahbubul Hoque Shafiqul A Sarker Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort study BMJ Public Health |
| title | Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort study |
| title_full | Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort study |
| title_fullStr | Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort study |
| title_full_unstemmed | Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort study |
| title_short | Severe infection incidence among young infants in Dhaka, Bangladesh: an observational cohort study |
| title_sort | severe infection incidence among young infants in dhaka bangladesh an observational cohort study |
| url | https://bmjpublichealth.bmj.com/content/3/2/e002383.full |
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