In a major breakthrough that could transform newborn care across Pakistan and other developing countries, researchers at the Aga Khan University (AKU) revealed that treating newborns with signs of serious bacterial infections at home or in nearby clinics can be just as safe and effective as hospital care — and at nearly half the cost.
The findings, drawn from large international trials involving more than 12,000 infants, including over 2,000 from Pakistan, challenge the longstanding notion that hospitalization is the only way to save babies from deadly infections like sepsis.
At a dissemination seminar organized by the Department of Paediatrics and Child Health at AKU today, experts highlighted that about 11 out of every 100 newborns develop sepsis or serious bacterial infections, making early detection and treatment critical.
Symptoms such as fever, fast breathing, chest indrawing, poor feeding, low body temperature, or lethargy — collectively referred to as Possible Serious Bacterial Infection (PSBI) — typically warrant immediate hospital admission.
However, in Pakistan, parents often avoid hospitalization due to the financial burden, loss of daily wages, and the challenges of managing care for other children at home.
“These results prove that we can decentralize newborn care without compromising quality,” said Prof. Fyezah Jehan, chair of the Department of Paediatrics and Child Health at the AKU and lead investigator of the Pakistani arm of the study. “With proper training, community support, and phased implementation, we can extend lifesaving care to the doorstep and dramatically reduce newborn deaths.”
She maintained that home treatment nearly halved costs, with hospitalization averaging Rs26,320 compared to Rs13,720 for community-based care.
The seminar featured a detailed presentation on how the concept of outpatient and home-based management of PSBI evolved globally, led by WHO expert Dr. Shamim Qazi, who traced the journey from the early 1990s to the first WHO guidelines issued in 2015. In a touching moment, the audience learned that the grandparents of the baby featured on the cover of those very guidelines were present at the seminar, and that child is now a healthy 10-year-old.
Pakistan’s contribution to the two major trials was significant, with 1,125 infants enrolled in the first study and 799 in the second. Conducted with WHO support, the trials took place at four leading pediatric centers in Karachi: the Sindh Government Children’s Hospital, the National Institute of Child Health (NICH), the Aga Khan Hospital for Women and Children in Kharadar, and the Sindh Institute of Child Health and Neonatology.
Infants with low- to moderate-risk symptoms were treated with simplified antibiotic regimens. Notably, high-risk infants, who require hospitalization, were excluded from the trials.
Researchers found no significant difference in health outcomes between babies treated at hospitals and those managed at home or outpatient clinics, provided that strict treatment protocols and follow-up mechanisms were maintained. Severe side effects were rare, and mortality rates were similar, or in some cases even lower, among the home-treated groups.
The implications for Pakistan’s overburdened healthcare system are profound.
Dr. Jamal Raza, speaking at the seminar, said the findings offer immense relief to doctors who feel compelled to keep newborns admitted for extended periods out of fear of negative outcomes. “If implemented, it would be a big relief for the hospital set-up,” he said, noting that institutions like NICH routinely manage four babies to a bed.
Dr. Mohsina Ibrahim painted a vivid picture of the strain, describing how NICH admitted 100 patients on just the preceding Friday and had 60 newborns waiting in the emergency room for beds.
Experts agreed that rationalizing hospital admissions would not only save resources but also allow doctors to focus better on critically ill newborns. “Reducing unnecessary hospitalisation will mean giving more attention to truly critical cases, which to me, we are currently neglecting because of our overloaded systems,” said WHO’s Dr. Yasir bin Nisar.
Ellen Thom from WHO emphasized that while WHO guidelines are influential, governments have the discretion to adapt or reject them based on local needs, offering the example of Sub-Saharan countries that introduced lifelong HIV treatment for mothers even before WHO officially recommended it. Dr. Salim Virani, Vice Provost for Research at AKU, stressed that while groundbreaking research is vital, the true challenge lies in translating it into action. “You can do fancy trials and guidelines, but they don’t implement themselves,” he remarked, calling for systematic rollout and community engagement to ensure sustainable success.
The seminar brought together a wide range of key decision-makers and experts from across Pakistan’s child health ecosystem, including representatives from the Sindh Government Children’s Hospital, National Institute of Child Health, Aga Khan University, Sindh Institute of Child Health and Neonatology, Pakistan Pediatric Association, ChildLife Foundation, Lady Health Workers Programme, and senior health officials from Balochistan, Sindh, and Khyber Pakhtunkhwa. With the commitment of both academia and government stakeholders, the landmark findings could pave the way for a revolution in neonatal healthcare delivery, making lifesaving care accessible and affordable for families across the country.
Published in News Daily on 27-April-2025.
