Innovative approach for potential scale-up to jump-start simplified management of sick young infants with possible serious bacterial infection when a referral is not feasible: Findings from implementation research

Autor: Alemayehu Bayray, Tadele Hailu, Shamim Qazi, Hagos Godefay, Samira Aboubaker, Afework Mulugeta, Yasir Bin Nisar, Abadi Leul, Rajiv Bahl, Loko Abraham, Ephrem Tekle, Wondwossen Terefe, Mengesha Fantaye
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Male
Pediatrics
Pulmonology
Physiology
Families
Case fatality rate
Outpatients
Infant Mortality
Medicine and Health Sciences
Children
education.field_of_study
Multidisciplinary
Respiration
Disease Management
Bacterial Infections
Anti-Bacterial Agents
Professions
Breathing
Population study
Medicine
Female
Infants
medicine.drug
Research Article
medicine.medical_specialty
Referral
Patients
Science
Population
World Health Organization
Supervisors
medicine
Humans
education
business.industry
Health Services Administration and Management
Infant
Newborn
Biology and Life Sciences
Neonates
Amoxicillin
Infant
Guideline
Pneumonia
Communication in Health Care
medicine.disease
Health Care
Age Groups
People and Places
Population Groupings
Implementation research
Gentamicins
business
Physiological Processes
Developmental Biology
Zdroj: PLoS ONE
PLoS ONE, Vol 16, Iss 2, p e0244192 (2021)
ISSN: 1932-6203
Popis: Background Neonatal bacterial infections are a common cause of death, which can be managed well with inpatient treatment. Unfortunately, many families in low resource settings do not accept referral to a hospital. The World Health Organization (WHO) developed a guideline for management of young infants up to 2 months of age with possible serious bacterial infection (PSBI) when referral is not feasible. Government of Ethiopia with WHO evaluated the feasibility of implementing this guideline to increase coverage of treatment. Objective The objective of this study was to implement a simplified antibiotic regimen (2 days gentamicin injection and 7 days oral amoxicillin) for management of sick young infants with PSBI in a programme setting when referral was not feasible to identify at least 80% of PSBI cases, achieve an overall adequate treatment coverage of at least 80% and document the challenges and opportunities for implementation at the community level in two districts in Tigray, Ethiopia. Methods Using implementation research, we applied the PSBI guideline in a programme setting from January 2016 to August 2017 in Raya Alamata and Raya Azebo Woredas (districts) in Southern Tigray, Ethiopia with a population of 260884. Policy dialogue was held with decision-makers, programme implementers and stakeholders at federal, regional and district levels, and a Technical Support Unit (TSU) was established. Health Extension Workers (HEWs) working at the health posts and supervisors working at the health centres were trained in WHO guideline to manage sick young infants when referral was not feasible. Communities were sensitized towards appropriate home care. Results We identified 854 young infants with any sign of PSBI in the study population of 7857 live births. The expected live births during the study period were 9821. Assuming 10% of neonates will have any sign of PSBI within the first 2 months of life (n = 982), the coverage of appropriate treatment of PSBI cases in our study area was 87% (854/982). Of the 854 sick young infants, 333 (39%) were taken directly to a hospital and 521 (61%) were identified by HEW at health posts. Of the 521 young infants, 27 (5.2%) had signs of critical illness, 181 (34.7%) had signs of clinical severe infection, whereas 313 (60.1%) young infants 7–59 days of age had only fast breathing pneumonia. All young infants with critical illness accepted referral to a hospital, while 117/181 (64.6%) infants with clinical severe infection accepted referral. Families of 64 (35.3%) infants with clinical severe infection refused referral and were treated at the health post with injectable gentamicin for 2 days plus oral amoxicillin for 7 days. All 64 completed recommended gentamicin doses and 63/64 (98%) completed recommended amoxicillin doses. Of 313 young infants, 7–59 days with pneumonia who were treated by the HEWs without referral with oral amoxicillin for 7 days, 310 (99%) received all 14 doses. No deaths were reported among those treated on an outpatient basis at health posts. But 35/477 (7%) deaths occurred among young infants treated at hospital. Conclusions When referral is not feasible, young infants with PSBI can be managed appropriately at health posts by HEWs in the existing health system in Ethiopia with high coverage, low treatment failure and a low case fatality rate. Moreover, fast breathing pneumonia in infants 7–59 days of age can be successfully treated at the health post without referral. Relatively higher mortality in sick young infants at the referral level health facilities warrants further investigation.
Databáze: OpenAIRE
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