Dear Neil and colleagues,
Thank you for an excellent series of discussions. Reading the contributions, I have been reflecting on the issue from the perspective of community health systems in low- and middle-income countries.
One important lesson is that preventing deaths from Group B Streptococcus (GBS) does not begin in the labour ward — it begins in the community.
Imagine two mothers.
The first delivers in a well-equipped hospital where her GBS status is known, antibiotics are available, and the baby is closely monitored. If the baby develops poor feeding or breathing difficulties, clinicians act immediately.
The second delivers in a rural setting where GBS screening is unavailable, the nearest health facility is several hours away, and the family believes that a sleepy baby is simply "resting after birth." By the time the baby develops grunting, poor feeding, or hypothermia, valuable hours have been lost.
The bacterium may be the same, but the outcome is determined by the health system surrounding the mother and newborn.
This discussion therefore reminds us that improving GBS outcomes requires more than clinical protocols. We also need strong antenatal counselling, birth preparedness, effective referral systems, postnatal home visits, and community education so that parents recognize newborn danger signs and seek care immediately.
In many countries, community health workers are the first contact for mothers after delivery. They may not diagnose GBS, but they can save lives by identifying newborn danger signs early, encouraging prompt referral, supporting follow-up after discharge, and reinforcing messages given during antenatal care. Integrating GBS awareness into existing maternal and newborn health programmes may therefore be a practical and cost-effective approach, particularly where universal screening is not yet feasible.
Another point that has received less attention is the long-term journey of survivors. Several colleagues have highlighted neurodevelopmental impairment following invasive GBS disease. This means that our responsibility should not end when the infection is treated successfully. Babies recovering from GBS meningitis or severe sepsis should, where possible, receive developmental follow-up, hearing assessments, vision screening, and family support so that disabilities are identified early and appropriate interventions can begin. Survival alone is not enough; every child deserves the opportunity to reach their full developmental potential.
Finally, I believe one message could resonate widely with both health professionals and parents:
"A newborn cannot tell us they have sepsis. They only change their behaviour. When a newborn suddenly feeds poorly, becomes unusually sleepy, struggles to breathe, or feels too hot or too cold, every hour matters. Treat these changes as a medical emergency, not as something to wait and see."
This simple message is relevant not only for GBS but for neonatal sepsis more broadly, regardless of the underlying pathogen.
Thank you all for this valuable discussion. It highlights that reducing newborn deaths from GBS will require collaboration between families, communities, frontline health workers, hospitals, researchers, and policymakers.
Best wishes,
Rabia
Ms. Rabia A. Khaji
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CHIFA profile: Rabia Abeid Khaji is the Head of Monitoring and Evaluation and TB Portfolio at SHDEPHA+ in Tanzania. Her professional work is fundamentally centered on overcoming barriers to health information access, particularly for healthcare professionals and vulnerable communities in low-resource settings. Her experience includes: - Gender and Equity Focus: She recently led a comprehensive TB gender assessment for Tanzania and contributed to the national TB Gender Operational Plan, directly engaging with the challenges of equitable access to health information and publishing. - Community-Led Monitoring: She developed frameworks for Community-Led Monitoring (CLM) of TB services, empowering communities to identify and report service gaps—a process that deeply resonates with understanding end-user needs in the evidence ecosystem. - Research and Advocacy: She co-authored published operational research on TB and has extensive experience presenting findings at international conferences, such as the Union World Conference on Lung Health, International Aids Society etc. I understand the critical importance of disseminating research findings effectively to impact policy and practice. - Stakeholder Engagement: She serves on the boards of the Tanzania STOP TB Partnership and the Tanzania TB Community Network (TTCN), and is a member of the SMART4TB Afro Community Advisory Board. These roles require constant collaboration with diverse stakeholders, from policymakers to community health workers.