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Community-based management and outcome of omphalitis in newborns in Karachi, Pakistan
Farah Naz Qamar1, Shiyam Sundar Tikmani2, Fatima Mir2
1Department of Paediatrics and Child Health, Aga Khan University, Karachi. farah.qamar@aku.edu
Insights
Community-based management of newborn omphalitis is effective, with high recovery rates even in resource-limited settings. This approach minimizes hospital referrals, demonstrating successful home or clinic-based therapy for neonatal umbilical infections.
Area of Science:
- Neonatal care
- Infectious diseases
- Public health
Background:
- Omphalitis, an umbilical cord infection in newborns, poses a significant health risk, particularly in low-income communities.
- Effective management strategies are crucial to reduce neonatal morbidity and mortality associated with omphalitis.
Purpose of the Study:
- To evaluate the clinical characteristics and treatment outcomes of newborns diagnosed with omphalitis.
- To assess the efficacy of community-based management, including home and clinic-based therapies, for neonatal omphalitis.
Main Methods:
- A descriptive study conducted in Karachi, Pakistan, from 2004 to 2007.
- Newborns with omphalitis were treated with topical gentian violet, oral cephalexin, combination therapy, or injectable antibiotics for severe cases.
- Outcomes were assessed at 48-72 hours and 7 days post-treatment initiation.
Main Results:
- Out of 1083 newborns with omphalitis, presentations ranged from cellulitis to sepsis.
- Among 943 newborns without sepsis, 99.5% improved within one week with community-based treatment.
- In cases with sepsis, 99.2% improved with parenteral antibiotics, indicating high treatment success.
Conclusions:
- Omphalitis management in resource-constrained settings can be effectively decentralized to community levels.
- Minimal hospital referral is required, highlighting the success of primary healthcare interventions.
- Further research is recommended to optimize therapeutic regimens for neonatal omphalitis.
Objectives:
To describe the clinical profile and outcome in newborns with omphalitis managed with home or clinic-based therapy.
Methods:
The descriptive study was conducted from September 2004 to August 2007 in three low-income communities in Karachi, Pakistan. Newborns with omphalitis detected by community health workers through active surveillance were referred to local clinics. Those with physician-confirmed omphalitis were treated for 7 days with topical gentian violet or oral cephalexin (as monotherapy) or topical gentian violet and oral cephalexin (combination therapy) at physician discretion, or injectable therapy (procaine penicillin and gentamicin) if clinical signs of sepsis were also present and family refused hospital referral. Follow-up was at 48-72 hours and 7 days. SPSS 16 was used for statistical analysis.
Results:
Among 1083 newborns with omphalitis, 578 (53.4%) had peri-umbilical cellulitis without purulent discharge; 365 (33.7%) had purulent discharge (with or without cellulitis); and 140 (13%) had omphalitis with sepsis Review of outcome data at one week showed that among 943 newborns without signs of sepsis, 938 (99.5%) had improved; 2 (0.2%) died, and 2 (0.2%) were lost to follow-up. There were 5 (3.6%) therapy failures, among 140 newborns with omphalitis and sepsis managed with parenteral antibiotics at 48 hours, but 139 (99.2%) had improved by one week, while 1 (0.8%) died.
Conclusion:
In resource-constrained environments, omphalitis can be managed in the community with minimal need for hospital referral. Further research to define optimal therapeutic regimens is needed.
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