(introduction...)

Globally, the major contributors to newborn mortality and morbidity are severe infections (such as sepsis, meningitis, pneumonia, neonatal tetanus, congenital syphilis, and ophthalmia where the prevalence of sexually transmitted diseases is high), diarrhoea, jaundice, hypoxic-ischaemic encephalopathy and severe birth trauma. These conditions often present with nonspecific signs. For the purposes of management at the health centre, diseases were grouped into four disease/emergency categories on the basis of urgency for action, similarity of signs, and similarity of management. Each diagnostic category or group included the most common reasons for medical (but not surgical) treatment in the first few weeks of life.

The four categories of newborn illness are:

1. Severe bacterial infection (emergency group)
2. Local bacterial infection
3. Severe jaundice
4. Not able to feed.

The diseases, their clinical presentation (danger signs), their diagnostic categories and possible maternal complications are listed in Table 1.

Case fatality for severe bacterial infections is high and it is very important that newborns with these infections are immediately recognized by the health worker responsible for triage. If needed, referral to hospital should be as rapid as possible. Treatment of newborn diseases at the health centre is limited due to the unpredictable severity of diseases and because oral antibiotics are not effective in the first week of life. Most newborns with severe bacterial infections also need supportive treatment that is not available at home (extra warmth, parenteral fluids, gavage feeding, oxygen, phototherapy) and will require transferral to a district hospital. The few measures that need to be taken before immediate referral are intramuscular injection of antibiotics, making sure the baby is warm, and feeding or giving fluids.

At the referral hospital there should be further refinement of the problem according to treatment group. Definitive diagnosis can be made only by laboratory investigations, which may not always be possible.