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    • Even with the limitations in the available data on DALYs

    2019-06-24

    Even with the limitations in the available data on DALYs, the funding gap is huge. The Research Investments in Global Health study analysed public and philanthropic infectious disease research awards to UK institutions (1997–2013), and compared them to the burden in DALYs, describing a new metric of “investment per DALY observed”. The results are stark: neonatal infectious diseases received the lowest investment of all infections, £0·01 per DALY. By contrast, HIV and malaria had investments of £0·46 and £0·34 per DALY (, ) and some neglected tropical diseases have strikingly high investments—eg, African trypanosomiasis received £9·06 per DALY. Attracting additional funding and increasing capacity is essential to meet research needs and must be matched with improved scientific reporting; the forthcoming Strengthening Publications Reporting Infections in Newborns Globally (SPRING) standards are an important step towards this Vinblastine sulfate goal. However, well funded research in neonatal infection is essential. In health facilities, high quality surveillance data can provide important information on cause and antimicrobial resistance. But such data require significant resources, including strengthening laboratory quality control and assurance measures, and use and appropriate interpretation of molecular diagnostics to detect pathogens (including viruses). More population-based data are needed; these are difficult to acquire because most neonatal deaths occur in the first few hours after birth when access to care may be limited. Results of the Aetiology of Neonatal Infections in South Asia (ANISA) study are awaited, and forthcoming work includes the funded by the Bill & Melinda Gates Foundation in south Asia and sub-Saharan Africa. Preventing infection depends on improving our understanding of maternal health, including maternal colonisation, as well as vertical transmission (HIV, malaria, other congenital infections, and ascending bacterial infections) and hospital-acquired infections, particularly with multiresistant Gram-negative bacteria. Infection control management is important, and interventions, isolated or as part of care bundles, need detailed, prospective evaluation in outbreak situations, such as those proposed by the . Improving case management partly depends on improving recognition of danger signs by carers and primary health centres. Clinical algorithms used for diagnosing possible serious bacterial infection could be improved through the use of bedside tests, such as pulse oximetry, as well as point of care tests. Clinical trials have recently examined whether outpatient care can be provided to neonates who are not critically ill and where referral for hospital treatment is not possible. These trials have informed new WHO guidelines. However, further research is needed to determine health-system requirements for implementation, and whether this approach reduces uptake of referral to hospital, which remains the standard of care. There are important bottlenecks in health systems to improving neonatal infection case management, and overcoming these, with appropriate metrics to track neonatal care coverage, are essential. Future trials need to focus on improving mortality outcomes in newborns with sepsis and defining management strategies in settings of varying levels of antimicrobial resistance. The optimum choice of drug, dose, and duration in settings of high resistance to WHO first-line empirical therapy is completely unknown. A joined-up approach from funders and research institutions is urgently needed to strengthen neonatal infection research. This could be through a formal prioritisation exercise leading to calls for specific research funding to support research on neonatal infection. Developing research capacity worldwide is essential to drive forward measures to reduce deaths and disability from neonatal infection, and to reduce gross inequities in health.
    On Oct 5, 2015, we launch the first 45 disease-specific pages of a major new online initiative involving all journals that will bring together an overview Seminar and relevant Reviews, Clinical Series, Commissions, research, Case Reports, and Clinical Pictures. Over the next 18 months or so when is complete, there will be online pages for 135 diseases, which we have identified by a combination of global burden of disease data and clinical practice needs. We hope that will help practising doctors make better informed decisions that ultimately lead to better lives of people worldwide, and help others who want to educate or update themselves keep abreast of the evolving evidence base. Importantly, these pages will be updated at regular intervals. The authors of newly commissioned Seminars have agreed to provide regular summaries of important new evidence for 4 years. Individual clinical editors will pull together newly published material from across the journals and post links to these on the page regularly.