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Background There is limited data on antibiotic treatment in hospitalized neonates in low- and middle-income countries (LMICs). We aimed to describe patterns of antibiotic use, pathogens, and clinical outcomes, and to develop a severity score predicting mortality in neonatal sepsis to inform future clinical trial design. Methods and findings Hospitalized infants Conclusion Antibiotic regimens used in neonatal sepsis commonly diverge from WHO guidelines, and trials of novel empiric regimens are urgently needed in the context of increasing antimicrobial resistance (AMR). The baseline NeoSep Severity Score identifies high mortality risk criteria for trial entry, while the NeoSep Recovery Score can help guide decisions on regimen change. NeoOBS data informed the NeoSep1 antibiotic trial (ISRCTN48721236), which aims to identify novel first- and second-line empiric antibiotic regimens for neonatal sepsis. Trial registration ClinicalTrials.gov, (NCT03721302). James Neal Russell and colleagues report a global neonatal sepsis observational cohort study (NeoOBS) exploring patterns of antibiotic use, pathogens and prediction of mortality in hospitalised neonates and young infants with sepsis. Author summary Why was this study done? Increasing trends in antimicrobial resistance (AMR) disproportionately affect neonates and young infants with sepsis in LMIC settings and undermine the effectiveness of WHO-recommended antibiotics. Despite this, longitudinal data on antibiotic management strategies and outcomes of hospitalized neonates and young infants with sepsis in low- and middle-income country (LMIC) settings are extremely limited, impeding the design of robust antibiotic trials. There is limited data to define risk stratification, inclusion, and escalation criteria in trials of sepsis in hospitalized neonates and young infants. What did the researchers do and find? In this large global, prospective, hospital-based observational study across 4 continents, including LMIC settings, there was a high mortality among infants with culture positive sepsis (almost 1 in 5), and a significant burden of antibiotic resistance. This study highlights wide variations in standard of care (SOC) for sepsis in neonates and young infants, with more than 200 different antibiotic combinations, significant divergence from WHO-recommended regimens, and frequent switching of antibiotics. A NeoSep Severity Score that defined patterns of mortality risk at baseline was developed from 4 non-modifiable and 6 modifiable factors that are feasible to measure across a range of LMIC hospital contexts. A NeoSep Recovery Score including the same modifiable factors (with the addition of cyanosis) predicted mortality on the following day during treatment. What do these findings mean? These data demonstrate that patterns of routine antibiotic use are now markedly divergent from global guidance. There is an urgent need for large pragmatic randomized controlled trials to address optimal empiric first- and second-line antibiotic treatment strategies in LMIC hospital settings with a significant AMR burden. The wide range of multiple antibiotic regimens routinely used as SOC suggests the need for novel trial designs. The NeoSep Severity Score and NeoSep Recovery Score informed inclusion and escalation criteria in the NeoSep1 antibiotic trial (ISRCTN48721236) that aims to identify novel first- and second-line empiric antibiotic regimens for neonatal sepsis.

Background: Final-year students studying in various health science institutes are usually very stressed about their studies so that they can complete their studies without any hurdles. This stress can lead to poor academic and professional results because psychological issues such as anxiety and depression are frequently overlooked and not treated. This study aimed to measure the prevalence of stress and also assess the level of stress symptoms among the final year students of health science institute in Bangladesh. Methods: A prospective cross-sectional study involving 134 final-year students of Bangladesh Health Professions Institute (BHPI), which is a well-known health science institute in Bangladesh measured the prevalence of stress and assessed the level of stress symptoms using the Academic Stress Scale (ASS-40). Data was collected through face-to-face interviews and analysed using SPSS software 25.0. Descriptive and inferential statistics were used to analyse the data retrieved from the students. The Pearson correlation coefficient was used to find any deep relation between the levels of stress symptoms of the students with their age. Results: The prevalence of stress symptoms among the 134 students was 68.60%. The scenario of having stress symptoms was higher among male students and factors like fear of failure (29.20%), followed by teacher-student relationship/teaching method (28.80%) with addressable factors including personal inadequacy (25.50%) working as a stressor for this students. A negligible association (p > 0.05) was found between the age and the level of stress of the students. Conclusion: More than two-thirds of the students experienced stress symptoms during the final days in their institutions. This implies that the educational system, means of teaching, teaching materials, teachers as well as the services provided by the institutions cannot provide a conducive environment for effective learning as well as creating a secure future for the students as long as they can cope with the academic pressure. A student's educational career is being nipped in the bud due to the weak system of our education and institutional system. [ABSTRACT FROM AUTHOR]

Personal hygiene which should be started from childhood and having proper knowledge and practice during this time period will help to attenuate the infectious disease, thus increase the productivity of an individual in his or her life cycle. Investigating the knowledge, attitude and practice regarding personal hygiene among primary school going children was the aim of this study. A school based cross sectional study involving 408 children by probability proportionate was carried out in eight government and private primary schools at Sadar Upazilla, Noakhali District. The mean age of the respondents were 9.77±1.62 years with equal numbers of boys and girls. Overall 78.4% (N=320) respondents had good knowledge regarding hygiene and the percentage was higher among girls (79.4%) compared to boys and there have been also significant correlation among knowledge, attitude and practice about personal hygiene (P= 0.000). The study also revealed that respondents having adequate knowledge of proper hygiene were more likely to have clean clothes and clean teeth (AOR 2.37, CI 1.2-4.6 and AOR 2.51, CI 1.4-4.5 respectively). Thus continuous health education and behavioral change program are essential and should be conducted frequently to improve overall hygiene situation. [ABSTRACT FROM AUTHOR]