Incidence and etiology of omphalitis in Pakistan: a community-based cohort study

Abstract

Introduction: Although omphalitis (umbilical infections) among newborns is common and a major cause of neonatal deaths in developing countries, information on its burden and etiology from community settings is lacking. This study aimed to determine the incidence and etiology of omphalitis in newborns in high neonatal mortality settings in Karachi, Pakistan. Methodology: Trained community health workers surveyed all new births in three low-income areas from September 2004 to August 2007. Pus samples from the umbilical stumps were obtained from babies with pre-defined signs of illness and subjected to culture and antimicrobial susceptibility testing. Results: Among 6904 births, 1501 (21.7%) newborns were diagnosed with omphalitis. Of these, 325 (21.6%) were classified as mild, 1042 (69.4%) as moderate, and 134 (8.9%) as severe; 141 (9.3%) were associated with clinical signs of sepsis. The incidence of omphalitis was 217.4/1000 live births; moderate-severe omphalitis 170.3 per 1000 live births; and associated with sepsis 20.4 per 1000 live births. Of 853 infants with purulent umbilical discharge, 64% yielded 583 isolates. The most common pathogens were Staphylococcus aureus, of which 291 (95.7%) were methicillin-susceptible Staphylococcus aureus (MSSA) and 13 (4.2%) methicillin-resistant S. aureus (MRSA); Streptococcus pyogenes 105 (18%); Group B beta-hemolytic streptococci 59 (10 %); Pseudomonas spp., 52 (8.9 %); Aeromonas spp. 19 (3.2%); and Klebsiella spp. 12 (2%). Conclusions: A high burden of omphalitis can be associated with sepsis among newborns in low-income communities in Pakistan. S. aureus is the most common pathogen isolated from umbilical pus. Appropriate low-cost prevention strategies need to be implemented.

Impact of different antiseptics on umbilical cord colonization and cord separation time

“…The incidence of omphalitis has decreased in industrialized countries over the years due to aseptic delivery techniques and clean cord care, and the incidence has been reported to be between 0.2% and 0.7% [5,24,25]. The rate of omphalitis was 1.5% in our study, which is higher than the rates reported from developed countries, but lower than in the developing world where this rate may be as high as 6%-10% [24][25][26]. We found no significant difference in the rate of omphalitis between the study groups.…”

Measuring coverage of WHO recommended Essential Newborn Care practices in the squatter settlements of Islamabad Capital Territory in Pakistan.

“…Safe cord care is an important component of ENC to keep newborns healthy and avoid cord infection or sepsis. Community-based data on the incidence of omphalitis in Pakistan shows 217 per 1000 live births in Pakistan, which is associated with sepsis among newborns in low-income communities in Pakistan (22). Among the three sub-components of safe cord care, we found that chlorohexidine or nothing was applied on the cords of only 20.2% newborns; a proven intervention to be effective against neonatal infections (23).…”

Red and Swollen Umbilical Region

“…• White blood cell count: 15,100/mL (15.1Â10 9 /L) with 56% neutrophils, 30% lymphocytes • Platelet count: 553Â10 3…”