Professor Sithembiso Velaphi is head of paediatrics at the Chris Hani Baragwanath Academic Hospital in Soweto, South Africa. The hospital, which is the largest in Africa, is one of 19 sites across 11 countries which is involved in one of the largest ever studies on the care of babies with sepsis. GARDP is running the study together with St George’s University of London and the Paediatric Infectious Disease Network (Penta).
GARDP asked Professor Velaphi, who specializes in neonatology, eight questions about his work and his passion for the field:
Why does neonatal sepsis cause so many deaths among newborns in sub-Saharan Africa?
There are many reasons for this. Often people don’t have access to healthcare facilities, providers or treatment. Neonatal sepsis is then diagnosed late and there are delays in starting antibiotic treatment. Sometimes inappropriate antibiotics are used because of a lack of laboratory facilities to identify causative pathogens. The underlying condition of the baby as well as non-bacterial infections and multidrug-resistant organisms also play a role.
What can be done to reduce the high rate of neonatal deaths in Southern Africa?
Reducing overcrowding in our wards and providing more beds with appropriate spacing would make a big difference. Providing adequate staff in neonatal units would also help a great deal. We need to enforce Infection Prevention and Control (IPC) practices, such as hand hygiene, as well as monitor and evaluate what is being done. Training staff on IPC and getting staff to take ownership of this would be key. Facility or unit leaders should prioritize IPC in their facilities. Promoting exclusive breastfeeding to help babies fight off viruses and bacteria is also vital.
What particular challenges do you face with neonatal sepsis at Chris Hani Baragwanath Academic Hospital?
We have a high incidence of sepsis, which is associated with a high mortality rate. We also have many patients infected with multidrug-resistant organisms. Often there are many patients in our wards and they have limited physical space. This leads to overcrowding. There are also relatively fewer numbers of nurses and medical staff. Often IPC is not adequately supervised and there are breaches in IPC practices. Overcrowding and understaffing can also exacerbate breaches in IPC practices.
GARDP has completed enrollment into one of the largest ever observational studies on the care of babies with sepsis. We’re very pleased that Chris Hani Baragwanath Academic Hospital is one of our sites. Why is it so important to gather information on the patterns and impact of neonatal sepsis?
It would help us understand the extent of the problem better. It would provide information about how sepsis commonly presents in newborns and how to identify risk factors for poor outcome. It would give us the opportunity to assess and potentially review our practices and improve on them. Findings from this study will help us to better understand the burden of sepsis, which we will be able to share with policymakers.
How do you hope the study will help to increase our understanding of neonatal sepsis and ultimately help more babies to survive and thrive?
We hope it’ll give us a better understanding of case fatality rates, as well as severity scores and how newborns respond to treatment. It would also be valuable to find out more about the impact of delays in starting appropriate treatment as well as the association between the delays in starting antibiotics and the outcomes for our neonates.
What does South Africa’s recently launched National Neonatal Sepsis Task Force hope to achieve?
It will enable us to have collaborations within South Africa to tackle neonatal sepsis. It gives us the platform to speak with one voice and have uniform guidelines and protocols. It will help with surveillance and has opened the way for more research collaborations. It will allow us to collectively help the South African government in developing policies and guidelines at national level.
What does it mean for you to work in neonatology?
I love being part of a team of people who care for newborn babies and who have so much patience and love for their work. It is rewarding working with people who are resilient despite major challenges. I’ve always wanted to play a role in helping those in need, especially vulnerable populations, and working in neonatology has given me the opportunity to do this.
What inspires you?
Trying to play a role in helping humankind, in supporting its survival. I’m inspired by teaching and training others, by impacting positively in their lives and enabling them to have a better future. It’s inspiring seeing people not giving up despite the odds. I like to help other people. I have managed to achieve what I have through being assisted by others. I want to keep that chain of love and support going.
Learn more about GARDP’s children’s antibiotics programme.