Research funded by the Wellcome Trust has highlighted the scale of the problem of hospital-acquired infections in sub-Saharan Africa. The study, published today in the ‘Lancet’, suggests that bloodstream infections acquired while in care might contribute to one in every 20 deaths that occur in children in hospitals in the region.
The issue of hospital-acquired infections is well recognised in high-income countries, with major initiatives promoting cleanliness among hospital staff and visitors. However, despite many African hospitals being severely overcrowded, and suffering frequent shortages of basic supplies such as running water and clean linen, virtually no data exist on the number of hospital-acquired infections in the region.
"The conditions in African hospitals are often poor, and it is very likely that these environments lead to considerable amounts of sickness among patients who are already debilitated by their primary illness," says Dr Anthony Scott from the KEMRI-Wellcome Trust Research Programme in Kilifi, Kenya. "And yet the fact is, there are no data from which we can guide both paediatric practice and hospital policy across sub-Saharan Africa."
In the largest ever study of hospital-acquired bacteraemia - bloodstream infections caused by invasive bacteria - in sub-Saharan Africa, researchers at the KEMRI-Wellcome Trust Research Programme examined more than 33 000 paediatric admissions to the Kilifi District Hospital in coastal Kenya between 2002 and 2009.
The researchers found that hospital-acquired bacteraemia infections occurred in six out of every 1000 paediatric inpatient admissions. Over half of these cases (53 per cent) died. Three-quarters of the cases were attributable to just six bacteria, including Klebsiella pneumoniae and Staphylococcus aureus, which are commonly identified in hospital-acquired infections in high-income countries.
Commenting on the results, Professor Aggrey Wasunna of the University of Nairobi said: "This is a wake-up call for all of those involved in the hospital care of children, especially in the resource-constrained regions.
"We know that these infections do occur, but they are often not given the priority they deserve, partly because they can be difficult to detect. The paediatric ward in Kilifi is well resourced and therefore levels of hospital-acquired infections are likely, if anything, to be lower than what may be found in many such hospitals across the region."
Dr Alex Aiken, a Wellcome Trust Research Training Fellow at the London School of Hygiene and Tropical Medicine and first author of the study, says that this research provides a starting point for future research and also for immediate efforts to reduce the burden of disease.
"Hospital-acquired bacteraemia infections are a serious problem for children in African hospitals, but now that we can recognise the problem, we can begin to take action," he says. "Many of the infections occurred in easily identifiable, high-risk patient groups like children with malnutrition, which should allow us to make targeted interventions. Simple measures like improved hand hygiene can have a large impact on hospital-acquired infections."
The KEMRI-Wellcome Trust Research Programme is one of the Wellcome Trust's major overseas programmes, which carry out vital research on diseases that cause high levels of morbidity and mortality in low-income countries.
Commenting on the new study, Dr Jimmy Whitworth, Head of International Activities at the Wellcome Trust, said: "Despite the best efforts of staff, hospitals in many parts of Africa face huge challenges due to lack of resources and overcrowding. This study has demonstrated the scale and seriousness of one of these challenges, hospital-acquired infections in children in Kenya, and has identified important risk factors for these. It will help form the basis for designing and implementing appropriate interventions, which have the potential to save thousands of lives."