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Dr Anna Seale @ MRF's Meningitis and Septicaemia 2019

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Neonatal Sepsis in sub Saharan Africa

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Dr Anna Seale @ MRF's Meningitis and Septicaemia 2019

  1. 1. Meningitis Research Foundation Neonatal Sepsis in sub-Saharan Africa Anna Seale1,2,3,4 1London School of Hygiene & Tropical Medicine 2Public Health England 3 Haramaya University, Ethiopia 4KEMRI-Welllcome Trust Research Programme I have no conflicts of interest to declare 18 October 2019
  2. 2. World War II Centre for Naval Analysis - warplanes https://www.trevorbragdon.com/blog/when-data-gives-the-wrong-solution Syed, Matthew. 2015. Black BoxThinking. NewYork: Penguin Random House. pp 33-37Strengthen the planes where the bullets are causing most damage
  3. 3. Neonatal sepsis – the diagnosis Seale et al Lancet Infectious Diseases 2014
  4. 4. Neonatal sepsis – morbidity Seale et al Paediatric Research 2013
  5. 5. Neonatal sepsis – compartmental model estimates Seale et al Paediatric Research 2013
  6. 6. Neonatal sepsis – population incidence based estimates Fleischmann-Struzek et al Lancet Resp 20183·0 million cases of neonatal sepsis based on these data – none from sub-SaharanAfrica
  7. 7. Neonatal sepsis – the aetiology Okomo U et al. Lancet Infect Dis 2019 • Staphylococcus aureus 25% (21–29) • Klebsiella spp 21% (16–27) • Escherichia coli 10% (8–10) • 151 studies • (82 since 2008) • 84534 neonates • 26 countries • Almost all in hospital
  8. 8. World War II Centre for Naval Analysis - warplanes https://www.trevorbragdon.com/blog/when-data-gives-the-wrong-solution Syed, Matthew. 2015. Black BoxThinking. NewYork: Penguin Random House. pp 33-37 AbrahamWald: those that return to base are those that survive Strengthening needed where the bullet holes aren’t seen
  9. 9. Neonatal sepsis – the example of Group B Streptococcus Lawn et al CID 2017
  10. 10. Neonatal sepsis – the aetiology Okomo U et al. Lancet Infect Dis 2019 • Staphylococcus aureus 25% (21–29) • Klebsiella spp 21% (16–27) • Escherichia coli 10% (8–10) • 151 studies • (82 since 2008) • 84534 neonates • 26 countries • Almost all in hospital Late onset pathogens and typically associated with hospital outbreaks
  11. 11. Neonatal sepsis – what are we missing Lawn et al CID 2017 Early-onset, high mortality, difficult to sample, difficult to detect in the lab
  12. 12. Neonatal sepsis – what does this mean? Saha et al Lancet 2018 ANISA: A robust, large, community based investigation of neonatal sepsis in South Asia Even the most robust observational study will be limited by survivor bias
  13. 13. Neonatal sepsis – we need to look at alternatives Blau D et alCID 2019 Study design – include those that don’t survive
  14. 14. Neonatal sepsis – we need to look at alternatives Sobanjo-ter-Meulen,A.Vaccine 2019 Study design – an intervention to prevent the deaths
  15. 15. World War II Centre for Naval Analysis - warplanes https://www.trevorbragdon.com/blog/when-data-gives-the-wrong-solution Syed, Matthew. 2015. Black BoxThinking. NewYork: Penguin Random House. pp 33-37 The analysis informed design of planes through theVietnam War and is considered to have substantially reduced casualties.
  16. 16. Thank you All those whose work is included here. All my colleagues and collaborators at LSHTM, KEMRI-WellcomeTrust Research Programme, Haramaya University and Public Health England. Particular thanks to Joy Lawn Anthony Scott Jay Berkley

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