Managing possible serious bacterial infection in young infants when referral is not feasible

World Health Organization
World Health Organization
Publication Year:
May 04, 2020
  • SDG 3 - Good Health and Well-Being


Infections are responsible for about one fifth of the world’s annual 2.7 million neonatal deaths. In South Asia and sub-Saharan Africa about one quarter of all neonatal deaths are due to infections. Many sick infants only have non-specific signs, and thus are not recognized to have infection. Even when the signs are detected, hospitalization and life-saving treatment may not be accessible, acceptable or affordable to families in settings with high newborn mortality. Key studies in South Asia and in Africa indicate that up to two thirds or more of families do not accept referral for hospitalization of a young infant with signs of infection.

About the Guidelines

In 2015 WHO developed a guideline, Managing possible serious bacterial infection in young infants when referral is not feasible to address this situation. It provides guidance on care for use in resource-limited settings or in settings where families with sick young infants do not accept or cannot access referral care, but can be managed in outpatient settings by an appropriately trained health worker. The guideline seeks to provide programmatic guidance on the role of CHWs and home visits in identifying signs of serious infections in neonates and young infants.

About the Joint Statement

To support the implementation of the guideline, WHO, UNICEF and other partners developed a Joint Statement (published in February 2017) which summarizes a systematic process for managing sick young infants up to 59 days of age with PSBI in resource-limited settings.

The purpose of the Joint Statement is to facilitate the introduction and implementation of the new guideline as part of national newborn and child health strategies. It targets governments, professional bodies, civil society and development partners working in the area of newborn and child health.

The Joint Statement provides options for the use of simplified antibiotic regimens that are both safe and effective for outpatient treatment of clinical severe infection and fast-breathing pneumonia among young infants weighing at least 1.5 kg. It emphasizes that the standard of care remains referral to hospital for inpatient treatment for sick young infants with any sign of clinical severe infection or critical illness. The simplified antibiotic regimens should only be offered to families when referral is not feasible.

Access the guideline here.


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