A research project led by the Ineos Oxford Institute for antimicrobial research (IOI) to study the cause and impact of antimicrobial-resistant sepsis in Nigeria has resulted in reduced new-born deaths, improved awareness about neonatal infection prevention amongst parents, and strengthened capacity and training for local doctors. The findings have been published in Nature Communications .
Sepsis and AMR
Nigeria has one of the world's highest infant death rates, with sepsis being a leading cause. This occurs when the body's immune system mounts an extreme response to an infection, which can lead to organ failure, then death. In 2017 alone, 2.9 million deaths from sepsis occurred in children younger than five years, many in sub-Saharan Africa.
Our study showed that when blood culture diagnostics are made available, treatment becomes more targeted, outcomes improve, and the death rate drops.
Lead author, Chinenye Akpulu, IOI
The main treatment for sepsis is antibiotics. But antibiotic overuse in humans and animals has led to antimicrobial resistance (AMR)- a process where bacteria stop responding to medicines. However, the link between AMR and sepsis is poorly understood in many low-and-middle income countries.
University of Oxford researchers have been working with 12 clinical hospital sites across six countries, including three hospitals in Nigeria (two in Abuja and one in Kano), to better understand the cause and impacts of AMR in sepsis cases. By building capacity and expertise in these locations, the study led to significant reductions in infant mortality.
Key outcomes:
With funding from the Bill and Melinda Gates Foundation, the first phase of the study (2015 - 2020) supported new diagnostic tools, recruitment of additional clinical staff, and construction of new laboratories. Staff had access to free blood culture testing, previously unaffordable for most families. This allowed earlier identification of bacterial infections and more appropriate use of antibiotics, critical in settings where AMR is widespread and first-line treatments such as ampicillin and gentamicin often fail. In one hospital, doctors reported an almost 50% decline in infant mortality from around 33% to 17% over the study period.
Lead author for the study Chinenye Akpulu, DPhil student at the IOI, said: 'In many low- and middle-income countries, clinicians are forced to treat new-born infections without access to laboratory confirmation, leading to overuse or misuse of antibiotics. This accelerates antibiotic resistance and puts lives at risk. Our study showed that when blood culture diagnostics are made available, treatment becomes more targeted, outcomes improve, and the death rate drops.'
Beyond reduced new-born death rates, further benefits included:
Researchers and clinicians in a hospital facility in Nigeria. Credit: Chinenye Akpulu.New-born intensive care units (NICUs) and laboratories were upgraded or built.
- Staff received hands-on training in molecular microbiology, with some going on to pursue advanced research qualifications.
- Research assistants recruited from the community enhanced patient engagement and follow-up, with over 6,000 mother-infant pairs enrolled.
Dr Kenneth C. Iregbu, Nigerian co-Principal Investigator based at the National Hospital Abuja, said: 'Through this study, we discovered that our first line of treatment, a combination of ampicillin and gentamicin, was ineffective in treating newborn babies with neonatal sepsis. This discovery helped save many lives and will continue to do so even after the study ends. We also noticed that patients were returning to the hospital as they were guaranteed to be seen by a physician.'
Research success and long-term sustainability
Despite these advances, the study also highlighted a fundamental challenge: the difficulty of long-term sustainability if externally-funded projects end. In the interim between the first and second phases of the project, it became clear that additional actions were needed for the positive impacts to be durable. For instance, some hospitals struggled to maintain access to key resources such as blood culture systems, and some families could no longer benefit from free diagnostics.
This underscores a common limitation in global health research: the infrastructure and systems built during a project risk degrading without coordinated, long-term planning.
Dr Kirsty Sands, Scientific Lead at the IOI and co-author of the study, said: 'While the outcomes of our research are promising and highlight the importance of AMR surveillance, it also raises important questions about sustaining research projects after funding ends. Without structured exit strategies, research may unintentionally harm the communities it intends to help.'
Implications for global health research
While the outcomes of our research are promising and highlight the importance of AMR surveillance, it also raises important questions about sustaining research projects after funding ends. Without structured exit strategies, research may unintentionally harm the communities it intends to help.
Study co-author, Dr Kirsty Sands , Scientific Lead at the IOI
According to the study team, these findings offer important lessons for research funders, global health institutions, and implementing partners:
- Plan for sustainability from the outset: Research projects should include exit strategies that address resource continuity, system integration, and handover of equipment and knowledge.
- Prioritise capacity strengthening as one of the primary outputs: Investments in training, infrastructure, and local leadership development can multiply long-term impact far beyond a project's original scope.
- Centre local perspectives in evaluation: This study was co-authored by Nigerian clinical and laboratory staff. Their reflections offered critical insights into what worked, what changed, and what still needs support- underscoring the importance of inclusive research authorship and interpretation.
- Engage local governments and funders early: Long-term impact requires coordinated national and sub-national investment. Involving local decision-makers from the outset increases the chances that diagnostic systems and workforce capacity are sustained after external funding ends.
Looking ahead
The second phase of the project, funded by the IOI, is currently underway across seven Nigerian hospitals, lasting up to 2026. This phase builds on lessons learned and aims to embed more sustainable diagnostic capacity, including a permanent laboratory with a solar-powered system to reduce reliance on unstable electricity supplies.
As neonatal sepsis continues to claim hundreds of thousands of lives globally each year, targeted investments in diagnostics, infrastructure, and local leadership remain vital. But just as vital is ensuring that the impact of research doesn't end when the funding does.
The study 'Beyond the samples: Nigerian research staff perspectives on a multicentre neonatal sepsis study's impact' has been published in Nature Communications . You can learn more about the project on the IOI website.
