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 |
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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. |
doi_str_mv | 10.1371/journal.pone.0232675 |
format | Article |
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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0232675</identifier><identifier>PMID: 32392209</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>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</subject><ispartof>PloS one, 2020-05, Vol.15 (5), p.e0232675-e0232675</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><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. 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 2020 World Health Organization</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-f236232503be67076407730750a50026f63b500e93a4277450091fa89c4984c3</citedby><cites>FETCH-LOGICAL-c692t-f236232503be67076407730750a50026f63b500e93a4277450091fa89c4984c3</cites><orcidid>0000-0001-7597-5249 ; 0000-0002-0208-053X ; 0000-0002-1484-0823</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/PMC7213695/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213695/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32392209$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Folgori, Laura</contributor><creatorcontrib>Rahman, Ahmed Ehsanur</creatorcontrib><creatorcontrib>Herrera, Samantha</creatorcontrib><creatorcontrib>Rubayet, Sayed</creatorcontrib><creatorcontrib>Banik, Goutom</creatorcontrib><creatorcontrib>Hasan, Rezaul</creatorcontrib><creatorcontrib>Ahsan, Ziaul</creatorcontrib><creatorcontrib>Siraj, Wahida</creatorcontrib><creatorcontrib>Ahmed, Anisuddin</creatorcontrib><creatorcontrib>Siddique, Abu Bakkar</creatorcontrib><creatorcontrib>Rahman, Qazi Sadeq-Ur</creatorcontrib><creatorcontrib>Vaz, Lara M E</creatorcontrib><creatorcontrib>Islam, M Jahurul</creatorcontrib><creatorcontrib>Hossain, M Altaf</creatorcontrib><creatorcontrib>Shahidullah, M</creatorcontrib><creatorcontrib>Osmani, M Mohiuddin</creatorcontrib><creatorcontrib>E L Arifeen, Shams</creatorcontrib><creatorcontrib>Wall, Stephen N</creatorcontrib><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</title><title>PloS one</title><addtitle>PLoS One</addtitle><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.</description><subject>Ambulatory pediatrics</subject><subject>Antibiotics</subject><subject>Bacterial diseases</subject><subject>Bacterial infections</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Caregivers</subject><subject>Case management</subject><subject>Computer and Information Sciences</subject><subject>Data collection</subject><subject>Diseases</subject><subject>Early experience</subject><subject>Family</subject><subject>Fatalities</subject><subject>Guidelines</subject><subject>Health care</subject><subject>Health care reform</subject><subject>Illnesses</subject><subject>Infant care</subject><subject>Infant mortality</subject><subject>Infants</subject><subject>Infection</subject><subject>Infections</subject><subject>Management</subject><subject>Medicine and Health 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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> |
fulltext | fulltext |
identifier | ISSN: 1932-6203 |
ispartof | PloS one, 2020-05, Vol.15 (5), p.e0232675-e0232675 |
issn | 1932-6203 1932-6203 |
language | eng |
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source | Public Library of Science (PLoS) Journals Open Access; DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
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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