Caregiver acceptability of the guidelines for managing young infants with possible serious bacterial infections (PSBI) in primary care facilities in rural Bangladesh
| Autor: | Sabbir Ahmed, Abdullah H Baqui, Nazma Begum, Taufique Joarder, Mahfuza Mousumi, Meagan Harrison, Mamun Ibne Moin, Jennifer A. Applegate, Asm Nawshad Uddin Ahmed, Mohammod Shahidullah, Joby George, Dipak Kumar Mitra, Salahuddin Ahmed, Jennifer A. Callaghan-Koru |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Rural Population Medical Doctors Health Care Providers Ambulatory Care Facilities Young infants Geographical Locations Families 0302 clinical medicine Antibiotics Outpatients Ambulatory Care Medicine and Health Sciences Quality of Care 030212 general & internal medicine Medical Personnel Children Bangladesh Multidisciplinary Antimicrobials Drugs Bacterial Infections Middle Aged Anti-Bacterial Agents Professions Caregivers Medicine Female Attitude to Health Infants Research Article Adult medicine.medical_specialty Asia Referral Patients Science 030231 tropical medicine MEDLINE Context (language use) Primary care World Health Organization Microbiology 03 medical and health sciences Social skills Microbial Control medicine Humans Pharmacology Treatment Guidelines Health Care Policy Primary Health Care business.industry Health Services Administration and Management Infant Biology and Life Sciences Focus group Health Care Age Groups Family medicine People and Places Patient Compliance Population Groupings Implementation research business |
| Zdroj: | PLoS ONE PLoS ONE, Vol 15, Iss 4, p e0231490 (2020) |
| ISSN: | 1932-6203 |
| Popis: | Introduction Many infants with possible serious bacterial infections (PSBI) do not receive inpatient treatment because hospital care may not be affordable, accessible, or acceptable for families. In 2015, WHO issued guidelines for managing PSBI in young infants (0–59 days) with simpler antibiotic regimens when hospital care is not feasible. Bangladesh adopted WHO’s guidelines for implementation in outpatient primary health centers. We report results of an implementation research study that assessed caregiver acceptability of the guidelines in three rural sub-districts of Bangladesh during early implementation (October 2015-August 2016). Methods We included 19 outpatient primary health centers involved in the initial rollout of the infection management guidelines. We extracted data for all PSBI cases (N = 192) from facility registers to identify gaps in referral feasibility, simplified antibiotic treatment, and follow-up. Focus group discussions (FGD) and in-depth interviews (IDI) were conducted with both caregivers (6 FGDs; 23 IDIs) and providers (2 FGDs; 28 IDIs) to assess caregiver acceptability of the guidelines. Results Referral to the hospital was not feasible for many families (83.3%; N = 160/192) and acceptance varied by infection severity. Barriers to referral feasibility included economic and household factors, and previous experiences with poor quality of care at the sub-district hospital. Conversely, providers and caregivers indicated high acceptability of simplified antibiotic treatment. 80% (N = 96/120) of infants with clinical severe infection for whom referral was not feasible returned to the facility for the second antibiotic injection. Some providers reported developing local solutions—including engaging informal providers in treatment of the infant—to address organizational barriers and promote treatment compliance. Follow-up of young infants receiving simplified treatment is critical, but only 67.4% (N = 87/129) of infants received fourth day follow-up. Some providers’ reported deviations from the guidelines that shifted responsibility of follow-up to the caregiver, which may have contributed to lapses. Conclusion Caregivers’ perception of trust and communication with providers were influential in caregiver acceptability of care. Few caregivers accepted referral to the sub-district hospital, suggesting low acceptability of this option. When referral was not feasible, many caregivers reported satisfaction with simplified antibiotic treatment. Local solutions described by providers require further examination in this context to assess the safety and potential value of these strategies in outpatient treatment. Our findings suggest strengthening providers’ interpersonal skills could improve caregiver acceptability of the guidelines. |
| Databáze: | OpenAIRE |
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