{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T15:46:28Z","timestamp":1788968788289,"version":"build-2803163510"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T00:00:00Z","timestamp":1740096000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wellcome Trust Digital Innovation Grant","award":["215742\/Z\/19\/Z"],"award-info":[{"award-number":["215742\/Z\/19\/Z"]}]},{"name":"Wellcome Trust Early Career Award","award":["227076\/Z\/23\/Z"],"award-info":[{"award-number":["227076\/Z\/23\/Z"]}]},{"name":"NIHR Global Health Research Professorial Fellowship","award":["NIHR302422"],"award-info":[{"award-number":["NIHR302422"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Neonatal sepsis is a major cause of mortality in low-resource settings. We assessed how neonatal sepsis guidelines were used in 2 Zimbabwean hospitals and 1 Malawian hospital.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Using routine data collected with the digital health intervention, Neotree, we retrospectively reviewed doctors\u2019 and nurses\u2019 agreement with national and World Health Organization (WHO) guideline recommendations for antibiotic prescription for sepsis. We compared clinical features and outcomes of neonates who should have received antibiotics as per guideline with those who actually received them and fitted a logistic regression model to identify features associated with prescription.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Data were collected between January 2021 and June 2022 from 10 868 neonates: 6045 admitted to Sally Mugabe Central Hospital (SMCH), 1094 to Chinhoyi Provincial Hospital (CPH) and 3729 to Kamuzu Central Hospital (KCH). Complete implementation of national guidelines would increase antibiotics at admission: from 2188 (38%) to 3745 (64%) at SMCH, 472 (44%) to 852 (79%) at CPH, and 1519 (41%) to 3043 (82%) at KCH. Clinical features of sepsis were frequently not acted on, but the case fatality rate was lower in those not prescribed antibiotics despite guideline recommendation. Application of WHO guidelines would increase antibiotic prescription to 91% at SMCH, 88% at CPH, and 77% in KCH. Maternal risk factors for sepsis, male gender, low birth weight, older age at admission, and spontaneous vaginal delivery were associated with higher rate of antibiotic prescription.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Guideline-recommended clinical signs for sepsis are inconsistently used, with clinicians using other features for antibiotic decision-making. Work is needed to revise clinical diagnostic algorithms in low-resource settings to ensure they are useful, usable and contextually appropriate.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piaf017","type":"journal-article","created":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T09:38:59Z","timestamp":1740130739000},"source":"Crossref","is-referenced-by-count":7,"title":["Assessing the Use of Neonatal Sepsis Guidelines and Antibiotic Prescription With Large-Scale Prospective Data From Zimbabwe and Malawi"],"prefix":"10.1093","volume":"14","author":[{"given":"Nushrat","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Primary Care and Public Health, Imperial College London , London ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwendoline","family":"Chimhini","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent and Women\u2019s Health, Faculty of Medicine and Health Sciences, University of Zimbabwe , Harare ,","place":["Zimbabwe"]},{"name":"Sally Mugabe Central Hospital Neonatal Unit , Harare ,","place":["Zimbabwe"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Som Kumar","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Population Health, London School of Hygiene and Tropical Medicine , London ,","place":["United Kingdom"]},{"name":"Human Development Report Office, United Nations Development Programme , New York, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Cortina-Borja","sequence":"additional","affiliation":[{"name":"Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health , London ,","place":["United 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