Effect of community-based newborn care implementation strategies on access to and effective coverage of possible serious bacterial infection (PSBI) treatment for sick young infants during COVID-19 pandemic.

Autor: Tiruneh GT; JSI Research & Training Institute Inc., Addis Ababa, Ethiopia., Fesseha N; JSI Research & Training Institute Inc., Addis Ababa, Ethiopia., Emaway D; JSI Research & Training Institute Inc., Addis Ababa, Ethiopia., Betemariam W; JSI Research & Training Institute Inc., Washington, DC, United States of America., Nigatu TG; Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia., Magge H; Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.; Ethiopia and Fenot Project-School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada., Hirschhorn LR; Feinberg School of Medicine and Havey Institute of Global Health, Northwestern University, Chicago, Illinois, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Mar 25; Vol. 19 (3), pp. e0300880. Date of Electronic Publication: 2024 Mar 25 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0300880
Abstrakt: Background: In Ethiopia, neonatal mortality is persistently high. The country has been implementing community-based treatment of possible serious bacterial infection (PSBI) in young infants when referral to a hospital is not feasible since 2012. However, access to and quality of PSBI services remained low and were worsened by COVID-19. From November 2020 to June 2022, we conducted implementation research to mitigate the impact of COVID-19 and improve PSBI management implementation uptake and delivery in two woredas in Ethiopia.
Methods: In April-May 2021, guided by implementation research frameworks, we conducted formative research to understand the PSBI management implementation challenges, including those due to the COVID-19 pandemic. Through a participatory process engaging stakeholders, we designed adaptive implementation strategies to bridge identified gaps using mechanism mapping to achieve implementation outcomes. Strategies included training and coaching, supportive supervision and mentorship, technical support units, improved supply of essential commodities, and community awareness creation about PSBI and COVID-19. We conducted cross-sectional household surveys in the two woredas before (April 2021) and after the implementation of strategies (June 2022) to measure changes in targeted outcomes.
Results: We interviewed 4,262 and 4,082 women who gave live birth 2-14 months before data collection and identified 374 and 264 PSBI cases in April 2021 and June 2022, respectively. The prevalence of PSBI significantly decreased (p-value = 0.018) from 8.7% in April 2021 to 6.4% while the mothers' care-seeking behavior from medical care for their sick newborns increased significantly from 56% to 91% (p-value <0.01). Effective coverage of severely ill young infants that took appropriate antibiotics significantly improved from 33% [95% CI: 25.5-40.7] to 62% [95% CI: 51.0-71.6]. Despite improvements in the uptake of PSBI treatment, persisting challenges at the facility and systems levels impeded optimal PSBI service delivery and uptake, including perceived low quality of service, lack of community trust, and shortage of supplies.
Conclusion: The participatory design and implementation of adaptive COVID-19 strategies effectively improved the uptake and delivery of PSBI treatment. Support systems were critical for frontline health workers to deliver PSBI services and create a resilient community health system to provide quality PSBI care during the pandemic. Additional strategies are needed to address persistent gaps, including improvement in client-provider interactions, supply of essential drugs, and increased social mobilization strategies targeting families and communities to further increase uptake.
Competing Interests: The authors declare that they have no competing interests. The authors [GT, NF, DE, and WB] work for JSI Research & Training Institute, Inc., a commercial company. This does not alter our adherence to PLOS ONE policies on sharing data and materials. One of the authors of this manuscript (HM) works for the Gates Foundation. We would like to declare that we do not have any conflict of interest with the Gates Foundation-paid staff in preparing this manuscript.
(Copyright: © 2024 Tiruneh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje