***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aims : To provide a comprehensive description of young infant admissions to a first referral level health facility in Kenya . These data , currently lacking , are important given present efforts to st and ardise their care through the integrated management of childhood illness ( IMCI ) and for prioritising both health care provision and disease prevention strategies . Methods : Prospect i ve , 18 month observational study in a Kenyan district hospital of all admissions less than 3 months of age to the paediatric ward . Results : A total of 1080 infants were studied .  Mortality was 18 % overall , though in those aged 0–7 days it was 34 % . Within two months of discharge a further 5 % of infants aged < 60 days on admission had died . Severe infection and prematurity together accounted for 57 % of inpatient deaths in those aged < 60 days , while jaundice and tetanus accounted for another 27 % . S pneumoniae , group B streptococcus , E coli , and Klebsiella spp . were the most common causes of invasive bacterial disease . Hypoxaemia , hypoglycaemia , and an inability to feed were each present in more than 20 % of infants aged 0–7 days . Both hypoxaemia and the inability to feed were associated with inpatient death ( OR 3.8 ( 95 % CI 2.5 to 5.8 ) and 7.4 ( 95 % CI 4.8 to 11.2 ) respectively ) . Conclusions : Young infants contribute substantially to  paediatric inpatient mortality at the first referral level , highlighting the need both for basic supportive care facilities and improved disease prevention strategies OBJECTIVES To quantify the main reasons for referral of infants and children from first-level health facilities to referral hospitals in sub-Saharan Africa and to determine what further supplies , equipment , and legal empowerment might be needed to manage such children when referral is difficult . METHODS In an observational study at first-level health facilities in Ug and a , the United Republic of Tanzania , and Niger , over 3 - 5 months , we prospect ively documented the diagnoses and severity of diseases in children using the st and ardized Integrated Management of Childhood Illness ( IMCI ) guidelines . We review ed the facilities for supplies and equipment and examined the legal constraints of health personnel working at these facilities . FINDINGS We studied 7195 children aged 2 - 59 months , of whom 691 ( 9.6 % ) were classified under a severe IMCI classification that required urgent referral to a hospital . Overall , 226 children had general danger signs , 292 had severe pneumonia or very severe disease , 104 were severely dehydrated , 31 had severe persistent diarrhoea , 207 were severely malnourished , and 98 had severe anaemia .  Considerably more ill were 415 young infants aged one week to two months : nearly three-quarters of these required referral . Legal constraints and a lack of simple equipment ( suction pumps , nebulizers , and oxygen concentrators ) and supplies ( nasogastric tubes and 50 % glucose ) could prevent health workers from dealing more appropriately with sick children when referral was not possible . CONCLUSION When referral is difficult or impossible , some additional supplies and equipment , as well as provision of simple guidelines , may improve management of seriously ill infants and children OBJECTIVE to estimate the prevalence and identify the determinants of non-prescription use of antibiotics for children in Mongolia . METHODS a community-based cross-sectional survey was undertaken in 10 subdistricts in Ulaanbaatar , Mongolia 's capital . We used a structured question naire to collect data from a r and om sample of 540 households with at least one child aged < 5 years .  Logistic regression was used to identify factors associated with antibiotic misuse . FINDINGS of 503 participating caregivers , 71 % were mothers ; 42.3 % ( 95 % confidence interval , CI : 37.8 - 46.9 ) of caregivers had used non-prescribed antibiotics to treat symptoms in their child during the previous 6 months . Symptoms commonly treated were cough ( 84 % ) , fever ( 66 % ) , nasal discharge ( 65 % ) and sore throat ( 60 % ) . Amoxicillin was the most commonly used antibiotic ( 58 % ) . Pharmacies were the main source ( 86 % ) of non-prescribed antibiotics . Non-prescribed use by mothers was significantly associated with keeping antibiotics at home ( odds ratio , OR : 1.7 ; 95 % CI : 1.04 - 2.79 ) , caregiver self-medication ( OR : 6.3 ; 95 % CI : 3.8 - 10.5 ) and older child 's age ( OR : 1.02 ; 95 % CI : 1.01 - 1.04 ) . Caregivers with a better knowledge of antibiotics were less likely to give children non-prescribed antibiotics ( OR : 0.7 ; 95 % CI : 0.6 - 0.8 ) . CONCLUSION the prevalence of non-prescribed antibiotic use for young children was high in Ulaanbaatar . Because such use leads to the spread of bacterial resistance to antibiotics and related health problems , our findings have important implication s for public education and the enforcement of regulations regarding the sale of antibiotics in Mongolia Background : In re source -limited setting s , most young infants with signs of severe infection do not receive the recommended inpatient treatment with intravenous broad spectrum antibiotics for 10 days or more because such treatment is not accessible , acceptable or affordable to families . This trial was initiated in the Democratic Republic of Congo , Kenya and Nigeria to assess the safety and efficacy of simplified treatment regimens for the young infants with signs of severe infection who can not receive hospital care . Methods : This is a r and omized , open-label equivalence trial in which 3600 young infants with signs of clinical severe infection will be enrolled . The primary outcome is treatment failure in 7 days after enrollment , which includes death or worsening of the clinical condition on any day , or no improvement in the clinical condition by day 4 of treatment . Secondary outcomes include compliance with study therapy , adverse effects due to the study drugs and relapse or death during the week after completion of treatment . Discussion : The results of this study , along with ongoing studies in Pakistan and Bangladesh , will inform the development of global policy for treatment of severe neonatal infections in re source -limited setting OBJECTIVE Little data has been published on the presenting symptoms and signs among ill infants aged < 60 days from developing countries . We aim ed to describe and evaluate the potential of simple clinical features to identify severe illness among young infants who present to rural district hospitals in Kenya . METHODS St and ardized assessment tools were design ed to record clinical symptoms and signs . Data were collected prospect ively on all infants aged < 60 days who weighed > or = 1.5 kg and were admitted over an 18-month period . The same data were collected , prospect ively from infants recruited to a contemporaneous hospital birth cohort who became ill and were assessed and treated as out patients at the same hospital . FINDINGS Data on 467 outpatient consultations and 769 inpatient episodes were available for analysis . These data highlighted the importance of findings in the history , particularly breathing difficulties , abnormal feeding , and abnormal behaviour , as well as clinical signs in the evaluation of young infants . They indicated possible important differences in the panel of signs useful for detecting severe illness in infants aged 0 - 6 days and those aged 7 - 59 days . They also showed that some simplification of current guidelines that still preserved the sensitivity and specificity for detecting very severe disease might be possible . CONCLUSION Simple clinical features may allow distinction between severe and non-severe illness to be made with reasonable confidence . Prospect i ve studies on an adequate scale are needed urgently to provide current integrated management of childhood illness guidelines for young infants with an adequate evidence base To determine the effect of antibiotic formulations on compliance , 400 children , aged 2 months to 5 years , with a presumptive diagnosis of pneumonia , were r and omly assigned to receive one of the following formulations of cotrimoxazole : 1 . syrup accompanied by a 10-ml measuring cup ; 2 . syrup accompanied by a 5-ml measuring spoon ; 3 . tablets ; 4 . single-dose sachets of antibiotic powder . A research assistant visited the childs ' home on the fourth day of therapy , asked the care-giver about compliance , and observed the care-giver prepare a dose of the medication . The remaining amount of medicine was measured , and when possible ( n = 151 ) , a urine specimen was tested for the presence of sulphamethoxazole . All of the care-givers reported giving at least one dose on the first day of therapy . By the fourth day , 82 per cent of those receiving syrup were still taking their medication compared to 71 and 55 per cent of those receiving sachets or tablets , respectively ( P < 0.01 ) . Of those who received syrup accompanied by a spoon , 38 per cent under-dosed the medicine by at least 30 per cent . Overall , compliance was highly correlated with the care-giver 's report of difficulty in administering the medication . Additional research is needed to underst and the obstacles encountered by care-givers in administering sachets and tablets . Meanwhile , the use of antibiotic syrup , accompanied by an appropriately sized measuring cup , appears to offer the greatest probability of medication compliance in the treatment of Egyptian children with pneumonia Objective To check the validity of Integrated Management of Neonatal and Childhood Illness ( IMNCI ) algorithm for young infants ( 0–2 months ) . Design Prospect i ve observational study . Setting The outpatient department and emergency room of a medical college attached hospital . Methods 419 infants ( 176 between 0–7 days , 243 between 7 days-2 months ) underwent a detailed diagnostic assessment and treatment as per the st and ard protocol of treating unit . These infants also underwent assessment , classification and identification of treatment as per IMNCI algorithm . The diagnostic and therapeutic agreement between st and ard protocol and IMNCI was computed to assess the validity of IMNCI algorithm . Results The IMNCI algorithm performed well in identifying sick young infants with sensitivity of 97 % , 94 % and 95 % , and specificity of 85 % , 87 % and 87 % in 0–7 days , 7 days-2 months and 0–2 months age groups , respectively . The algorithm covered majority ( 80 % ) of recorded diagnoses , and could identify bacterial infection with 88.5 % sensitivity and 57.4 % specificity . Complete diagnostic agreement with gold st and ard was seen in 50 % ; overdiagnosis and under diagnosis was seen in 13 % and 19 % , respectively . Low birthweight and upper respiratory infection were the main reasons for overdiagnosis whereas surgical conditions result ed in under diagnoses in majority . Conclusion IMNCI algorithm for evaluation and management of young infants has good sensitivity and specificity for referring cases with severe illness Antibiotics are utilized excessively in many areas of the world . To better define how often and why these drugs are used , we prospect ively studied antibiotic use among a cohort of 105 children less than five years of age in a poor area of the northeastern Brazilian city of Fortaleza . During a 16-week period , 65 children took 137 courses of antibiotics .  Physicians recommended 54 % of these , mothers or their associates 39 % , and pharmacy workers 7 % . Mothers and pharmacy workers recommended drugs for shorter courses than physicians , and were more likely to recommend drugs inappropriate for children . Duration of illness was not a risk factor for antibiotic use , but both poor nutritional status and poor socioeconomic status were . Health care seeking behaviour was further studied in 58 diarrhoea episodes . The type of care sought was related to the duration of illness . Overall ,  antibiotic use was very common and often inappropriate among children in this poor urban area . More controlled use might decrease the use of potentially dangerous drugs and the use of these drugs when no benefit is likely BACKGROUND About 500,000 sepsis-related deaths per year arise in the first 3 days of life . On the basis of results from non-r and omised studies , use of vaginal chlorhexidine wipes during labour has been proposed as an intervention for the prevention of early-onset neonatal sepsis in developing countries . We therefore assessed the efficacy of chlorhexidine in early-onset neonatal sepsis and vertical transmission of group B streptococcus . METHODS In a trial in Soweto , South Africa , 8011 women ( aged 12 - 51 years ) were r and omly assigned in a 1:1 ratio to chlorhexidine vaginal wipes or external genitalia water wipes during active labour , and their 8129 newborn babies were assigned to full-body ( intervention group ) or foot ( control group ) washes with chlorhexidine at birth , respectively . In a subset of mothers ( n=5144 ) , we gathered maternal lower vaginal swabs and neonatal skin swabs after delivery to assess colonisation with potentially pathogenic bacteria . Primary outcomes were neonatal sepsis in the first 3 days of life and vertical transmission of group B streptococcus . Analysis was by intention to treat . The trial is registered with Clinical Trials.gov , number NCT00136370 . FINDINGS Rates of neonatal sepsis did not differ between the groups ( chlorhexidine 141 [ 3 % ] of 4072 vs control  
    Output:
    
For question 2 , first-line injectable agents ( ampicillin , gentamicin , and penicillin ) had low variable availability in first-level health facilities in Africa and South Asia .
Oral amoxicillin and cotrimoxazole were widely available at low cost in most regions .
Trained frontline health workers may screen for pBI in young infants with relatively high sensitivity and lower specificity .
Availability of first-line injectable antibiotics appears low in many health facilities in Africa and Asia .