Dr. Adrien Lokangaka, a physician who earned a Master of Public Health in maternal and child health at the UNC Gillings School of Global Public Health in 2014, has published research that may make better use of scant medical resources in African countries and save the lives of infants with bacterial infections.
Dr. Lokangaka, a Rotary Peace fellow, is a member of the African Neonatal Sepsis Trial group, which conducted research at five sites in Democratic Republic of Congo, Kenya and Nigeria. Results were published online April 1 in The Lancet.
[Photo: Mothers and their babies wait to be seen in a clinic in Central African Republic (photo by Pierre Holtz/Unicef).Infant mortality is still a primary public health problem in developing countries, where one-quarter of infant deaths are due to infection. A preliminary study by a UNC alumnus found that oral antibiotics were as effective in stemming bacterial infections as were injectable antibiotics, the recommended treatment]
Pneumonia, sepsis and meningitis together cause the deaths of about 700,000 newborns each year. Since it is difficult to differentiate and diagnose these diseases, the World Health Organization recommends that newborns and young infants presenting with fever, low body temperature, fast breathing or other symptoms of distress be brought to hospital and treated for seven to 10 days with intravenous or intramuscular antibiotics.
Because of financial, transportation, cultural, and other constraints, a hospital visit is not practical or possible in many low- and middle-income countries, and inpatient care is often unavailable due to inadequate and poorly equipped hospitals.
Dr. Lokangaka and colleagues proposed oral amoxicillin as treatment for the symptom of rapid breathing in infants who could not make the trip to hospital, or who would not be able to reach the hospital quickly enough.
Rapid breathing is one of the first signs of bacterial infection in an infant.
Between April 2011 and April 2013, the study enrolled 2,333 infants three months old and younger. About half received injectable antibiotic (procaine benzylpenicillin-gentamicin), and half received oral amoxicillin. In the injectable treatment group, 22 percent of infants failed treatment, compared with 19 percent of infants in the oral treatment group. No drug-related adverse events were noted, and an equal number of infants (four) died from each group within 15 days of follow-up.
The study was not blind, due to the ethics of providing infants with placebo injections, and the authors call for further study and examination on a larger scale. However, the initial work indicates that young infants whose only symptom of bacterial infection is fast breathing can be treated as effectively with oral amoxicillin as with injected antibiotics when hospital referral is not practical or possible.
“Although neonatal mortality has declined in high-income countries over the past several decades, it is still one of the main public health problems in developing countries,” Dr. Lokangaka said. “One-quarter of neonatal and infant deaths are due to infection, and the majority of these deaths occur in developing countries. A significant reduction in infant mortality in these countries will not occur without a reduction in deaths due to infection.”
The research, funded by a Bill & Melinda Gates Foundation grant to the World Health Organization, was also part of Dr. Lokangaka’s master’s thesis paper.