May 4, 2015

Dr. Adrien Lokangaka

Dr. Adrien Lokangaka

Adrien Lokangaka, MD, MPH, 2014 graduate in maternal and child health at the Gillings School of Global Public Health, has published research that may make better use of scant medical resources in African countries and save the lives of infants with bacterial infections.

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.

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.

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,” 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.”

Lokangaka noted that a number of preventive strategies appear to reduce the likelihood of infection, including clean delivery practices, prompt treatment of chorioamnionitis (inflammation of amniotic membranes due to infection), early and exclusive breastfeeding, eye prophylaxis, and hygienic skin and umbilical cord care.

“Nevertheless,” he said, “there is no guarantee that these preventive measures will be successful at all times. When prevention of infection fails, neonatal sepsis often results in death. Without effective therapy, case fatality can be as high as 22 percent.”

Lokangaka said that community-based treatments are more practical because they do not require the inpatient care that is unavailable to many children in resource-poor settings in Africa. Oral treatment may be particularly useful because it is cheaper, affordable and has fewer risks than injections.

“We speculate that the widespread use of this simplified approach for treating neonates and young infants with signs of serious bacterial infection would result in more infants being treated more effectively,” he said. “This, in turn, would reduce mortality among young infants.”

The research, funded by a Bill & Melinda Gates Foundation grant to the World Health Organization, was also part of Lokangaka’s master’s thesis paper.


Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.
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