Managing possible serious bacterial infection of young infants where referral is not possible: Lessons from the early implementation experience in Kushtia District learning laboratory, Bangladesh

Serious infections account for 25% of global newborn deaths annually, most in low-resource settings where hospital-based treatment is not accessible or feasible. In Bangladesh, one-third of neonatal deaths are attributable to serious infection; in 2014, the government adopted new policy for outpatie...

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Veröffentlicht in:PloS one 2020-05, Vol.15 (5), p.e0232675-e0232675
Hauptverfasser: Rahman, Ahmed Ehsanur, Herrera, Samantha, Rubayet, Sayed, Banik, Goutom, Hasan, Rezaul, Ahsan, Ziaul, Siraj, Wahida, Ahmed, Anisuddin, Siddique, Abu Bakkar, Rahman, Qazi Sadeq-Ur, Vaz, Lara M E, Islam, M Jahurul, Hossain, M Altaf, Shahidullah, M, Osmani, M Mohiuddin, E L Arifeen, Shams, Wall, Stephen N
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container_issue 5
container_start_page e0232675
container_title PloS one
container_volume 15
creator Rahman, Ahmed Ehsanur
Herrera, Samantha
Rubayet, Sayed
Banik, Goutom
Hasan, Rezaul
Ahsan, Ziaul
Siraj, Wahida
Ahmed, Anisuddin
Siddique, Abu Bakkar
Rahman, Qazi Sadeq-Ur
Vaz, Lara M E
Islam, M Jahurul
Hossain, M Altaf
Shahidullah, M
Osmani, M Mohiuddin
E L Arifeen, Shams
Wall, Stephen N
description Serious infections account for 25% of global newborn deaths annually, most in low-resource settings where hospital-based treatment is not accessible or feasible. In Bangladesh, one-third of neonatal deaths are attributable to serious infection; in 2014, the government adopted new policy for outpatient management of danger signs indicating possible serious bacterial infections (PSBI) when referral was not possible. We conducted implementation research to understand what it takes for a district health team to implement quality outpatient PSBI management per national guidelines. PSBI management was introduced as part of the Comprehensive Newborn Care Package in 2015. The study piloted this package through government health systems with limited partner support to inform scale-up efforts. Data collection included facility register reviews for cases seen at primary level facilities; facility readiness and provider knowledge and skills assessments; household surveys capturing caregiver knowledge of newborn danger signs and care-seeking for newborn illness; and follow-up case tracking, capturing treatment adherence and outcomes. Analysis consisted of descriptive statistics. Over the 15-month implementation period, 1432 young infants received care, of which 649 (45%) were classified as PSBI. Estimated coverage of care-seeking increased from 22% to 42% during the implementation period. Although facility readiness and providers' skills increased, providers' adherence to guidelines was not optimal. Among locally managed PSBI cases, 75% completed the oral antibiotic course and 15% received the fourth day follow-up. Care-seeking remained high among private providers (95%), predominantly village health doctors (over 80%). Facility readiness, including health care provider knowledge and skills were strengthened; future efforts should focus on improving provider adherence to guidelines. Social and behavior change strategies targeting families and communities should explore shifting care-seeking from private, possibly less-qualified providers. Strategies to improve private sector management of PSBI cases and improved linkages between private and public sector providers could be explored.
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Analysis consisted of descriptive statistics. Over the 15-month implementation period, 1432 young infants received care, of which 649 (45%) were classified as PSBI. Estimated coverage of care-seeking increased from 22% to 42% during the implementation period. Although facility readiness and providers' skills increased, providers' adherence to guidelines was not optimal. Among locally managed PSBI cases, 75% completed the oral antibiotic course and 15% received the fourth day follow-up. Care-seeking remained high among private providers (95%), predominantly village health doctors (over 80%). Facility readiness, including health care provider knowledge and skills were strengthened; future efforts should focus on improving provider adherence to guidelines. Social and behavior change strategies targeting families and communities should explore shifting care-seeking from private, possibly less-qualified providers. 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M</au><au>Osmani, M Mohiuddin</au><au>E L Arifeen, Shams</au><au>Wall, Stephen N</au><au>Folgori, Laura</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Managing possible serious bacterial infection of young infants where referral is not possible: Lessons from the early implementation experience in Kushtia District learning laboratory, Bangladesh</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-05-11</date><risdate>2020</risdate><volume>15</volume><issue>5</issue><spage>e0232675</spage><epage>e0232675</epage><pages>e0232675-e0232675</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Serious infections account for 25% of global newborn deaths annually, most in low-resource settings where hospital-based treatment is not accessible or feasible. In Bangladesh, one-third of neonatal deaths are attributable to serious infection; in 2014, the government adopted new policy for outpatient management of danger signs indicating possible serious bacterial infections (PSBI) when referral was not possible. We conducted implementation research to understand what it takes for a district health team to implement quality outpatient PSBI management per national guidelines. PSBI management was introduced as part of the Comprehensive Newborn Care Package in 2015. The study piloted this package through government health systems with limited partner support to inform scale-up efforts. Data collection included facility register reviews for cases seen at primary level facilities; facility readiness and provider knowledge and skills assessments; household surveys capturing caregiver knowledge of newborn danger signs and care-seeking for newborn illness; and follow-up case tracking, capturing treatment adherence and outcomes. Analysis consisted of descriptive statistics. Over the 15-month implementation period, 1432 young infants received care, of which 649 (45%) were classified as PSBI. Estimated coverage of care-seeking increased from 22% to 42% during the implementation period. Although facility readiness and providers' skills increased, providers' adherence to guidelines was not optimal. Among locally managed PSBI cases, 75% completed the oral antibiotic course and 15% received the fourth day follow-up. Care-seeking remained high among private providers (95%), predominantly village health doctors (over 80%). Facility readiness, including health care provider knowledge and skills were strengthened; future efforts should focus on improving provider adherence to guidelines. Social and behavior change strategies targeting families and communities should explore shifting care-seeking from private, possibly less-qualified providers. Strategies to improve private sector management of PSBI cases and improved linkages between private and public sector providers could be explored.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32392209</pmid><doi>10.1371/journal.pone.0232675</doi><tpages>e0232675</tpages><orcidid>https://orcid.org/0000-0001-7597-5249</orcidid><orcidid>https://orcid.org/0000-0002-0208-053X</orcidid><orcidid>https://orcid.org/0000-0002-1484-0823</orcidid><oa>free_for_read</oa></addata></record>
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subjects Ambulatory pediatrics
Antibiotics
Bacterial diseases
Bacterial infections
Biology and Life Sciences
Care and treatment
Caregivers
Case management
Computer and Information Sciences
Data collection
Diseases
Early experience
Family
Fatalities
Guidelines
Health care
Health care reform
Illnesses
Infant care
Infant mortality
Infants
Infection
Infections
Management
Medicine and Health Sciences
Mortality
Neonatal diseases
Neonates
Newborn babies
Newborn infants
Patient compliance
People and Places
Physicians
Primary care
Private sector
Public sector
Sepsis
Setting (Literature)
Skills
Social behavior
Social interactions
Statistical analysis
title Managing possible serious bacterial infection of young infants where referral is not possible: Lessons from the early implementation experience in Kushtia District learning laboratory, Bangladesh
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