{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T07:27:50Z","timestamp":1788938870427,"version":"build-2803163510"},"reference-count":35,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T00:00:00Z","timestamp":1670284800000},"content-version":"unspecified","delay-in-days":5,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MC_PC_MR\/R019789\/1"],"award-info":[{"award-number":["MC_PC_MR\/R019789\/1"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,10,18]]},"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Accurate and timely diagnosis of common neonatal conditions is crucial for reducing neonatal deaths. In low\/middle-income countries with limited resources, there is sparse information on how neonatal diagnoses are made. The aim of this study was to describe the diagnostic criteria used for common conditions in neonatal units (NNUs) in Nigeria and Kenya.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>\n                      Prospective observational study. Standard case report forms for suspected sepsis, respiratory disorders, birth asphyxia and abdominal conditions were co-developed by the Neonatal Nutrition Network (\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.lstmed.ac.uk\/nnu\">https:\/\/www.lstmed.ac.uk\/nnu<\/jats:ext-link>\n                      ) collaborators. Clinicians completed forms for all admissions to their NNUs. Key data were displayed using heatmaps.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Five NNUs in Nigeria and two in Kenya comprising the Neonatal Nutrition Network.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>2851 neonates, which included all neonates admitted to the seven NNUs over a 6-month period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>1230 (43.1%) neonates had suspected sepsis, 874 (30.6%) respiratory conditions, 587 (20.6%) birth asphyxia and 71 (2.5%) abdominal conditions. For all conditions and across all NNUs, clinical criteria were used consistently with sparse use of laboratory and radiological criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings highlight the reliance on clinical criteria and extremely limited use of diagnostic technologies for common conditions in NNUs in sub-Saharan Africa. This has implications for the management of neonatal conditions which often have overlapping clinical features. Strategies for implementation of diagnostic pathways and investment in affordable and sustainable diagnostics are needed to improve care for these vulnerable infants.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-064575","type":"journal-article","created":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T09:35:30Z","timestamp":1670319330000},"page":"e064575","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Prospective observational study of the challenges in diagnosing common neonatal conditions in Nigeria and Kenya"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9782-0798","authenticated-orcid":false,"given":"Aimee P","family":"Staunton","sequence":"first","affiliation":[{"name":"Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1056-729X","authenticated-orcid":false,"given":"Helen M","family":"Nabwera","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"},{"name":"Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen J","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"},{"name":"Department of Gastroenterology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olukemi O","family":"Tongo","sequence":"additional","affiliation":[{"name":"Institute of Child Health, University College Hospital Ibadan, Ibadan, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abimbola E","family":"Akindolire","sequence":"additional","affiliation":[{"name":"Institute of Child Health, University College Hospital Ibadan, Ibadan, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isa","family":"Abdulkadir","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinyere V","family":"Ezeaka","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice N","family":"Ezenwa","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iretiola B","family":"Fajolu","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria"},{"name":"Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab O","family":"Imam","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic D","family":"Umoru","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Maitama District Hospital, Abuja, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter","family":"Otieno","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Maseno University, Maseno, Kenya"},{"name":"Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace M","family":"Nalwa","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health, Maseno University, Maseno, Kenya"},{"name":"Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Macrine","family":"Olwala","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9328-6903","authenticated-orcid":false,"given":"Alison W","family":"Talbert","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline E A","family":"Andang'o","sequence":"additional","affiliation":[{"name":"Department of Public Health, Maseno University, Maseno, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha K","family":"Mwangome","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ismaela","family":"Abubakar","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas D","family":"Embleton","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK"},{"name":"Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,6]]},"reference":[{"key":"2025121422433590000_12.12.e064575.1","unstructured":"United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) . Levels and trend in child mortality report, 2020."},{"key":"2025121422433590000_12.12.e064575.2","unstructured":"Healthy Newborn Network . Explore Countries- Nigeria. healthynewbornnetwork.org, 2017. Available: https:\/\/www.healthynewbornnetwork.org\/country\/nigeria\/"},{"key":"2025121422433590000_12.12.e064575.3","unstructured":"National Academies of Sciences Engineering and Medicine . Improving diagnosis in health care. National Academies Press, 2015."},{"key":"2025121422433590000_12.12.e064575.4","unstructured":"World Health Organization . Everybody\u2019s business-strengthening health systems to improve health outcomes: WHO\u2019s framework for action, 2007"},{"key":"2025121422433590000_12.12.e064575.5","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1016\/S0140-6736(21)00673-5","article-title":"The Lancet Commission on diagnostics: transforming access to diagnostics","volume":"398","author":"Fleming","year":"2021","journal-title":"Lancet"},{"key":"2025121422433590000_12.12.e064575.6","first-page":"2537","article-title":"Neonatal septicaemia in poor resource settings","volume":"2","author":"Pius","year":"2017","journal-title":"Pediatric Infect Dis"},{"key":"2025121422433590000_12.12.e064575.7","unstructured":"The World Bank . World bank country and lending groups. worldbank.org, 2018. Available: https:\/\/datahelpdesk.worldbank.org\/knowledgebase\/articles\/906519"},{"key":"2025121422433590000_12.12.e064575.8","unstructured":"World Health Organization . Progress report: reaching every newborn national 2020 milestones: country progress plans and moving forward, 2018."},{"key":"2025121422433590000_12.12.e064575.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30104-1"},{"key":"2025121422433590000_12.12.e064575.10","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0244109","article-title":"Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya","volume":"16","author":"Nabwera","year":"2021","journal-title":"PLoS One"},{"key":"2025121422433590000_12.12.e064575.11","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1111\/1471-0528.12312","article-title":"Standardisation of neonatal clinical practice","volume":"120 Suppl 2","author":"Bhutta","year":"2013","journal-title":"BJOG"},{"key":"2025121422433590000_12.12.e064575.12","unstructured":"Federal Ministry of Health . Nigeria every newborn action plan: a plan to end preventable newborn deaths in Nigeria, 2016."},{"key":"2025121422433590000_12.12.e064575.13","unstructured":"Ministry of Health . Health Ministry launches policy to accelerate gains in child health, 2018. Available: http:\/\/www.health.go.ke\/health-ministry-launches-policytoaccelerate-gains-in-child-health-nairobi-kenya-november-19-2018\/"},{"key":"2025121422433590000_12.12.e064575.14","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-10-30"},{"key":"2025121422433590000_12.12.e064575.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2016-000132"},{"key":"2025121422433590000_12.12.e064575.16","doi-asserted-by":"crossref","DOI":"10.4103\/0975-7406.90100","article-title":"The Nigerian health care system: need for integrating adequate medical intelligence and surveillance systems","volume":"3","author":"Welcome","year":"2011","journal-title":"J Pharm Bioallied Sci"},{"key":"2025121422433590000_12.12.e064575.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2019-001937"},{"key":"2025121422433590000_12.12.e064575.18","unstructured":"Liverpool School of Tropical Medicine . About the neonatal nutrition network. Available: https:\/\/www.lstmed.ac.uk\/research\/departments\/clinicalsciences\/neonatal-nutritionnetwork\/about-the-neonatal-nutrition"},{"key":"2025121422433590000_12.12.e064575.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"2025121422433590000_12.12.e064575.20","unstructured":"IMB Corp . IBM SPSS statistics for windows, version 20.0, 2011."},{"key":"2025121422433590000_12.12.e064575.21","unstructured":"World Health Organization . Pocket book of hospital care for children: guidelines for the management of common childhood illnesses, 2013."},{"key":"2025121422433590000_12.12.e064575.22","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-1991"},{"key":"2025121422433590000_12.12.e064575.23","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2019-0230"},{"key":"2025121422433590000_12.12.e064575.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-001136"},{"key":"2025121422433590000_12.12.e064575.25","unstructured":"UNICEF . Country office annual report- Kenya, 2018. Available: unicef.org"},{"key":"2025121422433590000_12.12.e064575.26","doi-asserted-by":"crossref","first-page":"3351","DOI":"10.1039\/C7LC00374A","article-title":"Point-of-care diagnostics to improve maternal and neonatal health in low-resource settings","volume":"17","author":"Majors","year":"2017","journal-title":"Lab Chip"},{"key":"2025121422433590000_12.12.e064575.27","doi-asserted-by":"crossref","first-page":"S26","DOI":"10.1016\/S0140-6736(97)90085-4","article-title":"Syndromic approaches to disease management","volume":"349","author":"Mabey","year":"1997","journal-title":"The Lancet"},{"key":"2025121422433590000_12.12.e064575.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2017.05.007"},{"key":"2025121422433590000_12.12.e064575.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2012.12.003"},{"key":"2025121422433590000_12.12.e064575.30","doi-asserted-by":"publisher","DOI":"10.1183\/20734735.000716"},{"key":"2025121422433590000_12.12.e064575.31","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1093\/pch\/pxy028","article-title":"Hypothermia for newborns with hypoxic-ischemic encephalopathy","volume":"23","author":"Lemyre","year":"2018","journal-title":"Paediatr Child Health"},{"key":"2025121422433590000_12.12.e064575.32","first-page":"1","article-title":"Implementing diagnostic imaging services in a rural setting of extreme poverty: five years of X-ray and ultrasound service delivery in Achham, Nepal","volume":"1","author":"Filkins","year":"2015","journal-title":"J Glob Radiol"},{"key":"2025121422433590000_12.12.e064575.33","doi-asserted-by":"publisher","DOI":"10.1053\/j.sempedsurg.2017.11.002"},{"key":"2025121422433590000_12.12.e064575.34","doi-asserted-by":"crossref","first-page":"S169","DOI":"10.1093\/infdis\/jis044","article-title":"Opportunities and challenges for cost-efficient implementation of new point-of-care diagnostics for HIV and tuberculosis","volume":"205 Suppl 2","author":"Schito","year":"2012","journal-title":"J Infect Dis"},{"key":"2025121422433590000_12.12.e064575.35","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(13)70250-0"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-064575","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T06:43:51Z","timestamp":1765781031000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-064575"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12]]},"references-count":35,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,6]]},"published-print":{"date-parts":[[2022,12]]}},"alternative-id":["10.1136\/bmjopen-2022-064575"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-064575","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12]]}}}