neonatal acquisition of esbl-pe in a low-income country - neolic

Conditions: Enterobacteriaceae Infections

Summary: enterobacteriaceae, more specifically escherichia coli and klebsiella pneumoniae, are the bacteria most often responsible for neonatal infections in low-income countries. infections caused by multidrug-resistant enterobacteriaceae: extended-spectrum beta-lactamase-producing enterobacteriaceae (esbl-e), are more often associated with an unfavorable outcome of the infection. enterobacteriaceae colonize the digestive tract which is the first step in developing a potential infection. very few studies have been carried out at the community level. colonization of the mother with esbl-e is generally considered to be a major route of acquisition. the carrying of esbl-e by other family members and other potential sources of transmission (food, objects and surfaces in contact with the newborn) have never been documented. in addition, with a view to offering an intervention adapted to the local context, the local cultural determinants which govern the interactions of the newborn with his environment are important to understand.

this is a single-center prospective cohort of all members living in the same household in which a newborn baby has just been born. the study consists to: * recruit a cohort of all members of 60 households in which a newborn has just been born * carry out semi-structured interviews and direct participant observation. this study is divided in two parts : * the epidemiological part : the documentation of colonization by e-esbl by sampling the stools of the newborn, of all members of the household, and sampling of food given to the child, from surfaces in contact with it. * the anthropological part : semi-structured interviews with key people in the structuring of the social and family environment of the newborn and participant direct observation of households.

Eligibility criteria:
inclusion criteria: 1. for the epidemiological study : all members of 60 households in which a newborn baby has just been born inclusion criteria for the mother at the time of childbirth, pregnant woman : _ having a monofetal pregnancy * residing regularly in the study area or planning to reside in the study area during the study period; * having been informed of the research and collection of biological samples on herself and her newborn; * having given its agreement to carry out the research and the associated collection of biological samples, and; * having signed the informed consent (or its witness if applicable). inclusion criteria for the live newborn at the time of childbirth, new born : * living after childbirth; * whose parents or legal representatives present: * reside regularly in the study area or plan to reside in the study area during the study period; * were informed of the research and the associated collection of biological samples on their newborn; * have given their agreement to carry out the research and the associated collection of biological samples, inclusion criteria for the household member, resident: * from the same household as the mother-child (ren) couple included * residing at least 4 nights per week in this home * having given its agreement to carry out the research and the associated collection of biological samples, * and having signed the consent of the study (or its witness, or its legal representative if applicable) 2. for the anthropological study with interviews : 16 homes will be selected from among the 60 homes included: 8 homes in which the child has not acquired an esbl-e during the entire follow-up and 8 homes in which the child has acquired an esbl-e at least once during its follow-up. among these households, interviews will be carried out with: 16 mothers or first responsible for the child in the absence of the mother 4 people with a mothering role on the child (grandmother, aunts ...) 4 minors in the families to observe 4 fathers or father figures in families to observe also, interviews will be done with: health actors: medical (1 midwife and 1 neighborhood doctor) and traditional (1 matron and 1 traditional practitioner from the neighborhood), 1 community health worker 1 neighborhood chief inclusion criteria for semi-structured interviews : * people responding to the structuring functions of the child's social and family environment * having given its agreement to carry out the research, * and having signed the consent of the study (or its witness, or its legal representative if applicable) for health workers and district managers, inclusion criteria for semi-structured interviews : * people responding to the targeted functions * working in the district of homes included * having given its agreement to carry out the research, * and having signed the consent of the study (or its witness, or its legal representative if applicable) 3. for the anthropological study with observations 4 households in total among the 16 initially selected for the interviews: 2 households in which the child did not acquire esbl-e during all the follow-up and 2 households in which the child acquired at least once an blse-e during his follow-up inclusion criteria for participating direct observations * residents of the same household as the mother-child (ren) couple included * having agreed to participate in the study * having given its agreement to carry out the research, * and having signed the consent of the study (or its witness, or its legal representative if applicable) exclusion criteria: 1. for the epidemiological part: * pregnant woman: non-monofetal pregnancy * newborn: died during childbirth * household resident: none 2. and 3) for the anthropological part: • semi-structured interview: for household members: * not responding to the structural family and social functions of the child's environment for health workers and district managers * people not meeting the targeted functions * not practicing in the district of homes included • participant direct observation: * not living in the same household as the mother-child couple included

Keywords: new born intra-domiciliary transmission community madagascar