Feasibility of implementing the World Health Organization case management guideline for possible serious bacterial infection among young infants in Ntcheu district, Malawi
Neonatal sepsis is a leading cause of mortality, yet the recommended inpatient treatment options are inaccessible to most families in low-income settings. In 2015, the World Health Organization released a guideline for outpatient treatment of young infants (0-59 days of age) with possible serious ba...
Gespeichert in:
| Veröffentlicht in: | PloS one 2020-04, Vol.15 (4), p.e0229248-e0229248 |
|---|---|
| Hauptverfasser: | , , , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | e0229248 |
|---|---|
| container_issue | 4 |
| container_start_page | e0229248 |
| container_title | PloS one |
| container_volume | 15 |
| creator | Guenther, Tanya Mopiwa, Gladson Nsona, Humphreys Qazi, Shamim Makuluni, Regina Fundani, Chancy Banda Gomezgani, Jenda Mgalula, Leslie Chisema, Mike Sadruddin, Salim |
| description | Neonatal sepsis is a leading cause of mortality, yet the recommended inpatient treatment options are inaccessible to most families in low-income settings. In 2015, the World Health Organization released a guideline for outpatient treatment of young infants (0-59 days of age) with possible serious bacterial infection (PSBI) with simplified antibiotic regimens when referral was not feasible. If implemented widely, this guideline could prevent many deaths. Our implementation research evaluated the feasibility and acceptability of implementing the WHO guideline through the existing health system in Malawi.
A prospective cohort study was conducted in 12 first-level health facilities in Ntcheu district. Trained health workers identified and treated young infants with PSBI signs with injection gentamicin for 2 days and oral amoxicillin for 7 days, whereas those with only fast breathing were treated with oral amoxicillin for 7 days. Health Surveillance Assistants (HSAs) were trained to promote care-seeking and to conduct home visits on day 3 and 6 to assess infants under treatment, encourage treatment adherence and remind the caregiver to return for facility follow up. Infants receiving outpatient treatment were followed up at health facility on day 4 and 8. The primary outcome was proportion of outpatient cases completing treatment per protocol.
A total of 358 infants received outpatient treatment (202 clinical severe infection, 156 only fast breathing) from February to September 2017. Of these, 92.7% (332/358) met criteria for treatment completion and 88.8% (318/358) completed the day 4 follow-up. Twelve (3.4%) young infants clinically failed treatment with no reported deaths in those treated at outpatient level. This treatment failure rate was lower than those reported for the simplified regimens tested in the SATT (8-10%) and AFRINEST (5-8%) equivalency trials. More than half of infants (58.1%; 208/358) received HSA follow-up visits on days 3 and 6.
Study results demonstrate the feasibility of outpatient treatment for sick young infants when referral is not feasible in Malawi, which will inform scale-up in other parts of Malawi and countries with similar health system constraints. |
| doi_str_mv | 10.1371/journal.pone.0229248 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_plos_</sourceid><recordid>TN_cdi_plos_journals_2389677380</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_c9f307cfdb0840a8aada9b71a3aa4660</doaj_id><sourcerecordid>2389677380</sourcerecordid><originalsourceid>FETCH-LOGICAL-c526t-519f9cdf6c8e855b1c7df6fa59422868cd67c532a87e0ec19ed1ce6352b0978a3</originalsourceid><addsrcrecordid>eNptUk1vEzEQXSEQLYV_gMASFw4k-CPr9V4qoYrSSoVeQBytWe9s4shrB9sLCn-JP4nTpFWLuHjG4_fefHiq6iWjcyYa9n4dpujBzTfB45xy3vKFelQds1bwmeRUPL7nH1XPUlpTWgsl5dPqSHCuGi75cfXnHCHZzjqbtyQMxI4bhyP6bP2S5BWS7yG6nlwguLwi13EJ3v6GbIMnBhKSETwsbwhkOdkenfVIhhDJJqSi65AkjDZMiXRgcnHBEesHNDcSMIaSZhumcpYo-JyKJV-yWeFEeptytCa_I5_BwS_7vHoygEv44mBPqm_nH7-eXcyurj9dnn24mpmayzyrWTu0ph-kUajqumOmKZcB6nZR2pbK9LIxteCgGqRoWIs9MyhFzTvaNgrESfV6r7txIenDnJPmQrWyaYSiBXG5R_QB1noT7QhxqwNYfRMIcakhZmscatMOgjZm6DuqFhQUQA9t1zAQAAspd1qnh2xTN2JvyigjuAeiD1-8Xell-KkbVkuqVBF4exCI4ceEKevRJoPOgccy-FJ3S1ktasUK9M0_0P93t9ijTCyfGHG4K4ZRvdu9W5be7Z4-7F6hvbrfyB3pdtnEX58B3SI</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2389677380</pqid></control><display><type>article</type><title>Feasibility of implementing the World Health Organization case management guideline for possible serious bacterial infection among young infants in Ntcheu district, Malawi</title><source>Public Library of Science (PLoS) Journals Open Access</source><source>PubMed Central Free</source><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Free Full-Text Journals in Chemistry</source><creator>Guenther, Tanya ; Mopiwa, Gladson ; Nsona, Humphreys ; Qazi, Shamim ; Makuluni, Regina ; Fundani, Chancy Banda ; Gomezgani, Jenda ; Mgalula, Leslie ; Chisema, Mike ; Sadruddin, Salim</creator><contributor>Sacks, Emma</contributor><creatorcontrib>Guenther, Tanya ; Mopiwa, Gladson ; Nsona, Humphreys ; Qazi, Shamim ; Makuluni, Regina ; Fundani, Chancy Banda ; Gomezgani, Jenda ; Mgalula, Leslie ; Chisema, Mike ; Sadruddin, Salim ; Sacks, Emma</creatorcontrib><description>Neonatal sepsis is a leading cause of mortality, yet the recommended inpatient treatment options are inaccessible to most families in low-income settings. In 2015, the World Health Organization released a guideline for outpatient treatment of young infants (0-59 days of age) with possible serious bacterial infection (PSBI) with simplified antibiotic regimens when referral was not feasible. If implemented widely, this guideline could prevent many deaths. Our implementation research evaluated the feasibility and acceptability of implementing the WHO guideline through the existing health system in Malawi.
A prospective cohort study was conducted in 12 first-level health facilities in Ntcheu district. Trained health workers identified and treated young infants with PSBI signs with injection gentamicin for 2 days and oral amoxicillin for 7 days, whereas those with only fast breathing were treated with oral amoxicillin for 7 days. Health Surveillance Assistants (HSAs) were trained to promote care-seeking and to conduct home visits on day 3 and 6 to assess infants under treatment, encourage treatment adherence and remind the caregiver to return for facility follow up. Infants receiving outpatient treatment were followed up at health facility on day 4 and 8. The primary outcome was proportion of outpatient cases completing treatment per protocol.
A total of 358 infants received outpatient treatment (202 clinical severe infection, 156 only fast breathing) from February to September 2017. Of these, 92.7% (332/358) met criteria for treatment completion and 88.8% (318/358) completed the day 4 follow-up. Twelve (3.4%) young infants clinically failed treatment with no reported deaths in those treated at outpatient level. This treatment failure rate was lower than those reported for the simplified regimens tested in the SATT (8-10%) and AFRINEST (5-8%) equivalency trials. More than half of infants (58.1%; 208/358) received HSA follow-up visits on days 3 and 6.
Study results demonstrate the feasibility of outpatient treatment for sick young infants when referral is not feasible in Malawi, which will inform scale-up in other parts of Malawi and countries with similar health system constraints.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0229248</identifier><identifier>PMID: 32287262</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Amoxicillin ; Antibiotics ; Bacterial diseases ; Bacterial infections ; Bacterial Infections - epidemiology ; Biology and Life Sciences ; Case Management ; Clinical trials ; Community ; Failure rates ; Families & family life ; Fatalities ; Feasibility Studies ; Follow-Up Studies ; Gentamicin ; Guidelines as Topic ; Health care facilities ; Health facilities ; Health surveillance ; Humans ; Infant ; Infant, Newborn ; Infants ; Infections ; Malawi - epidemiology ; Medical personnel ; Medicine and Health Sciences ; Neonates ; Newborn babies ; Outpatients ; People and Places ; Sepsis ; Treatment Outcome ; World Health Organization</subject><ispartof>PloS one, 2020-04, Vol.15 (4), p.e0229248-e0229248</ispartof><rights>2020 World Health Organization. License: http://creativecommons.org/licenses/by/3.0/igo/ (the “License”) e Public Library of Science. This is an open access article distributed under the Creative Commons Attribution IGO License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/3.0/igo/. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 World Health Organization. Licensee Public Library of Science 2020 World Health Organization. Licensee Public Library of Science</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c526t-519f9cdf6c8e855b1c7df6fa59422868cd67c532a87e0ec19ed1ce6352b0978a3</citedby><cites>FETCH-LOGICAL-c526t-519f9cdf6c8e855b1c7df6fa59422868cd67c532a87e0ec19ed1ce6352b0978a3</cites><orcidid>0000-0002-9688-9259 ; 0000-0002-5192-2983 ; 0000-0001-6023-2477</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156088/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7156088/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32287262$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Sacks, Emma</contributor><creatorcontrib>Guenther, Tanya</creatorcontrib><creatorcontrib>Mopiwa, Gladson</creatorcontrib><creatorcontrib>Nsona, Humphreys</creatorcontrib><creatorcontrib>Qazi, Shamim</creatorcontrib><creatorcontrib>Makuluni, Regina</creatorcontrib><creatorcontrib>Fundani, Chancy Banda</creatorcontrib><creatorcontrib>Gomezgani, Jenda</creatorcontrib><creatorcontrib>Mgalula, Leslie</creatorcontrib><creatorcontrib>Chisema, Mike</creatorcontrib><creatorcontrib>Sadruddin, Salim</creatorcontrib><title>Feasibility of implementing the World Health Organization case management guideline for possible serious bacterial infection among young infants in Ntcheu district, Malawi</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Neonatal sepsis is a leading cause of mortality, yet the recommended inpatient treatment options are inaccessible to most families in low-income settings. In 2015, the World Health Organization released a guideline for outpatient treatment of young infants (0-59 days of age) with possible serious bacterial infection (PSBI) with simplified antibiotic regimens when referral was not feasible. If implemented widely, this guideline could prevent many deaths. Our implementation research evaluated the feasibility and acceptability of implementing the WHO guideline through the existing health system in Malawi.
A prospective cohort study was conducted in 12 first-level health facilities in Ntcheu district. Trained health workers identified and treated young infants with PSBI signs with injection gentamicin for 2 days and oral amoxicillin for 7 days, whereas those with only fast breathing were treated with oral amoxicillin for 7 days. Health Surveillance Assistants (HSAs) were trained to promote care-seeking and to conduct home visits on day 3 and 6 to assess infants under treatment, encourage treatment adherence and remind the caregiver to return for facility follow up. Infants receiving outpatient treatment were followed up at health facility on day 4 and 8. The primary outcome was proportion of outpatient cases completing treatment per protocol.
A total of 358 infants received outpatient treatment (202 clinical severe infection, 156 only fast breathing) from February to September 2017. Of these, 92.7% (332/358) met criteria for treatment completion and 88.8% (318/358) completed the day 4 follow-up. Twelve (3.4%) young infants clinically failed treatment with no reported deaths in those treated at outpatient level. This treatment failure rate was lower than those reported for the simplified regimens tested in the SATT (8-10%) and AFRINEST (5-8%) equivalency trials. More than half of infants (58.1%; 208/358) received HSA follow-up visits on days 3 and 6.
Study results demonstrate the feasibility of outpatient treatment for sick young infants when referral is not feasible in Malawi, which will inform scale-up in other parts of Malawi and countries with similar health system constraints.</description><subject>Amoxicillin</subject><subject>Antibiotics</subject><subject>Bacterial diseases</subject><subject>Bacterial infections</subject><subject>Bacterial Infections - epidemiology</subject><subject>Biology and Life Sciences</subject><subject>Case Management</subject><subject>Clinical trials</subject><subject>Community</subject><subject>Failure rates</subject><subject>Families & family life</subject><subject>Fatalities</subject><subject>Feasibility Studies</subject><subject>Follow-Up Studies</subject><subject>Gentamicin</subject><subject>Guidelines as Topic</subject><subject>Health care facilities</subject><subject>Health facilities</subject><subject>Health surveillance</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infants</subject><subject>Infections</subject><subject>Malawi - epidemiology</subject><subject>Medical personnel</subject><subject>Medicine and Health Sciences</subject><subject>Neonates</subject><subject>Newborn babies</subject><subject>Outpatients</subject><subject>People and Places</subject><subject>Sepsis</subject><subject>Treatment Outcome</subject><subject>World Health Organization</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>DOA</sourceid><recordid>eNptUk1vEzEQXSEQLYV_gMASFw4k-CPr9V4qoYrSSoVeQBytWe9s4shrB9sLCn-JP4nTpFWLuHjG4_fefHiq6iWjcyYa9n4dpujBzTfB45xy3vKFelQds1bwmeRUPL7nH1XPUlpTWgsl5dPqSHCuGi75cfXnHCHZzjqbtyQMxI4bhyP6bP2S5BWS7yG6nlwguLwi13EJ3v6GbIMnBhKSETwsbwhkOdkenfVIhhDJJqSi65AkjDZMiXRgcnHBEesHNDcSMIaSZhumcpYo-JyKJV-yWeFEeptytCa_I5_BwS_7vHoygEv44mBPqm_nH7-eXcyurj9dnn24mpmayzyrWTu0ph-kUajqumOmKZcB6nZR2pbK9LIxteCgGqRoWIs9MyhFzTvaNgrESfV6r7txIenDnJPmQrWyaYSiBXG5R_QB1noT7QhxqwNYfRMIcakhZmscatMOgjZm6DuqFhQUQA9t1zAQAAspd1qnh2xTN2JvyigjuAeiD1-8Xell-KkbVkuqVBF4exCI4ceEKevRJoPOgccy-FJ3S1ktasUK9M0_0P93t9ijTCyfGHG4K4ZRvdu9W5be7Z4-7F6hvbrfyB3pdtnEX58B3SI</recordid><startdate>20200414</startdate><enddate>20200414</enddate><creator>Guenther, Tanya</creator><creator>Mopiwa, Gladson</creator><creator>Nsona, Humphreys</creator><creator>Qazi, Shamim</creator><creator>Makuluni, Regina</creator><creator>Fundani, Chancy Banda</creator><creator>Gomezgani, Jenda</creator><creator>Mgalula, Leslie</creator><creator>Chisema, Mike</creator><creator>Sadruddin, Salim</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0002-9688-9259</orcidid><orcidid>https://orcid.org/0000-0002-5192-2983</orcidid><orcidid>https://orcid.org/0000-0001-6023-2477</orcidid></search><sort><creationdate>20200414</creationdate><title>Feasibility of implementing the World Health Organization case management guideline for possible serious bacterial infection among young infants in Ntcheu district, Malawi</title><author>Guenther, Tanya ; Mopiwa, Gladson ; Nsona, Humphreys ; Qazi, Shamim ; Makuluni, Regina ; Fundani, Chancy Banda ; Gomezgani, Jenda ; Mgalula, Leslie ; Chisema, Mike ; Sadruddin, Salim</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c526t-519f9cdf6c8e855b1c7df6fa59422868cd67c532a87e0ec19ed1ce6352b0978a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Amoxicillin</topic><topic>Antibiotics</topic><topic>Bacterial diseases</topic><topic>Bacterial infections</topic><topic>Bacterial Infections - epidemiology</topic><topic>Biology and Life Sciences</topic><topic>Case Management</topic><topic>Clinical trials</topic><topic>Community</topic><topic>Failure rates</topic><topic>Families & family life</topic><topic>Fatalities</topic><topic>Feasibility Studies</topic><topic>Follow-Up Studies</topic><topic>Gentamicin</topic><topic>Guidelines as Topic</topic><topic>Health care facilities</topic><topic>Health facilities</topic><topic>Health surveillance</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infants</topic><topic>Infections</topic><topic>Malawi - epidemiology</topic><topic>Medical personnel</topic><topic>Medicine and Health Sciences</topic><topic>Neonates</topic><topic>Newborn babies</topic><topic>Outpatients</topic><topic>People and Places</topic><topic>Sepsis</topic><topic>Treatment Outcome</topic><topic>World Health Organization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Guenther, Tanya</creatorcontrib><creatorcontrib>Mopiwa, Gladson</creatorcontrib><creatorcontrib>Nsona, Humphreys</creatorcontrib><creatorcontrib>Qazi, Shamim</creatorcontrib><creatorcontrib>Makuluni, Regina</creatorcontrib><creatorcontrib>Fundani, Chancy Banda</creatorcontrib><creatorcontrib>Gomezgani, Jenda</creatorcontrib><creatorcontrib>Mgalula, Leslie</creatorcontrib><creatorcontrib>Chisema, Mike</creatorcontrib><creatorcontrib>Sadruddin, Salim</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - Academic</collection><collection>ProQuest Engineering Collection</collection><collection>ProQuest Biological Science Collection</collection><collection>Agricultural Science Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Engineering Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Environmental Science Database</collection><collection>Materials Science Collection</collection><collection>Access via ProQuest (Open Access)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>Genetics Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Guenther, Tanya</au><au>Mopiwa, Gladson</au><au>Nsona, Humphreys</au><au>Qazi, Shamim</au><au>Makuluni, Regina</au><au>Fundani, Chancy Banda</au><au>Gomezgani, Jenda</au><au>Mgalula, Leslie</au><au>Chisema, Mike</au><au>Sadruddin, Salim</au><au>Sacks, Emma</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Feasibility of implementing the World Health Organization case management guideline for possible serious bacterial infection among young infants in Ntcheu district, Malawi</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-04-14</date><risdate>2020</risdate><volume>15</volume><issue>4</issue><spage>e0229248</spage><epage>e0229248</epage><pages>e0229248-e0229248</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Neonatal sepsis is a leading cause of mortality, yet the recommended inpatient treatment options are inaccessible to most families in low-income settings. In 2015, the World Health Organization released a guideline for outpatient treatment of young infants (0-59 days of age) with possible serious bacterial infection (PSBI) with simplified antibiotic regimens when referral was not feasible. If implemented widely, this guideline could prevent many deaths. Our implementation research evaluated the feasibility and acceptability of implementing the WHO guideline through the existing health system in Malawi.
A prospective cohort study was conducted in 12 first-level health facilities in Ntcheu district. Trained health workers identified and treated young infants with PSBI signs with injection gentamicin for 2 days and oral amoxicillin for 7 days, whereas those with only fast breathing were treated with oral amoxicillin for 7 days. Health Surveillance Assistants (HSAs) were trained to promote care-seeking and to conduct home visits on day 3 and 6 to assess infants under treatment, encourage treatment adherence and remind the caregiver to return for facility follow up. Infants receiving outpatient treatment were followed up at health facility on day 4 and 8. The primary outcome was proportion of outpatient cases completing treatment per protocol.
A total of 358 infants received outpatient treatment (202 clinical severe infection, 156 only fast breathing) from February to September 2017. Of these, 92.7% (332/358) met criteria for treatment completion and 88.8% (318/358) completed the day 4 follow-up. Twelve (3.4%) young infants clinically failed treatment with no reported deaths in those treated at outpatient level. This treatment failure rate was lower than those reported for the simplified regimens tested in the SATT (8-10%) and AFRINEST (5-8%) equivalency trials. More than half of infants (58.1%; 208/358) received HSA follow-up visits on days 3 and 6.
Study results demonstrate the feasibility of outpatient treatment for sick young infants when referral is not feasible in Malawi, which will inform scale-up in other parts of Malawi and countries with similar health system constraints.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32287262</pmid><doi>10.1371/journal.pone.0229248</doi><orcidid>https://orcid.org/0000-0002-9688-9259</orcidid><orcidid>https://orcid.org/0000-0002-5192-2983</orcidid><orcidid>https://orcid.org/0000-0001-6023-2477</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-04, Vol.15 (4), p.e0229248-e0229248 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2389677380 |
| source | Public Library of Science (PLoS) Journals Open Access; PubMed Central Free; MEDLINE; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; Free Full-Text Journals in Chemistry |
| subjects | Amoxicillin Antibiotics Bacterial diseases Bacterial infections Bacterial Infections - epidemiology Biology and Life Sciences Case Management Clinical trials Community Failure rates Families & family life Fatalities Feasibility Studies Follow-Up Studies Gentamicin Guidelines as Topic Health care facilities Health facilities Health surveillance Humans Infant Infant, Newborn Infants Infections Malawi - epidemiology Medical personnel Medicine and Health Sciences Neonates Newborn babies Outpatients People and Places Sepsis Treatment Outcome World Health Organization |
| title | Feasibility of implementing the World Health Organization case management guideline for possible serious bacterial infection among young infants in Ntcheu district, Malawi |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T11%3A39%3A37IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Feasibility%20of%20implementing%20the%20World%20Health%20Organization%20case%20management%20guideline%20for%20possible%20serious%20bacterial%20infection%20among%20young%20infants%20in%20Ntcheu%20district,%20Malawi&rft.jtitle=PloS%20one&rft.au=Guenther,%20Tanya&rft.date=2020-04-14&rft.volume=15&rft.issue=4&rft.spage=e0229248&rft.epage=e0229248&rft.pages=e0229248-e0229248&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0229248&rft_dat=%3Cproquest_plos_%3E2389677380%3C/proquest_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2389677380&rft_id=info:pmid/32287262&rft_doaj_id=oai_doaj_org_article_c9f307cfdb0840a8aada9b71a3aa4660&rfr_iscdi=true |