Caregiver acceptability of the guidelines for managing young infants with possible serious bacterial infections (PSBI) in primary care facilities in rural Bangladesh

Applegate, Jennifer A.; Ahmed, Salahuddin; Harrison, Meagan; Callaghan-Koru, Jennifer A.; Mousumi, Mahfuza; Begum, Nazma; Moin, Mamun Ibne; Joarder, Taufique; Ahmed, Sabbir; George, Joby; Mitra, Dipak Kumar; Ahmed, Asm Nawshad Uddin; Shahidullah, Mohammod; Baqui, Abdullah H

doi:10.1371/journal.pone.0231490

Cited by 25 publications

(42 citation statements)

References 47 publications

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“…We had reasonable treatment coverage of approximately 60% in our study. Similar implementation research studies on PSBI in young infants from African and Asian countries reported variable treatment coverages of 16.3% in Sylhet and Chittagong in Bangladesh [24], 50% in Ethiopia [25], 42% in Kushtia district, Bangladesh [26], 63.8% in Malawi [27] and 95% in Nigeria [28]. Thus, except for the Nigeria study, our coverage proportions were comparable with other reported coverages.…”

Section: Discussionsupporting

confidence: 87%

Feasibility of implementation of simplified management of young infants with possible serious bacterial infection when referral is not feasible in tribal areas of Pune district, Maharashtra, India

et al. 2020

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Introduction Neonatal infections are a common cause of death in India, but many families cannot access appropriate hospitals for its treatment due to various reasons. We implemented the World Health Organization PSBI management guideline when referral is not feasible within the public health system in Pune, India to evaluate feasibility, barriers and facilitators for its implementation. Methods A national-level consultative meeting between government officials and study partners resulted in a consensus on adaptation and implementation in four demonstration sites in selected states in India. At the state and district levels, similar meetings to plan the implementation strategy and roles were held between KEM Hospital Research Centre (KEMHRC) Pune and the public health system Pune, Maharashtra. The public health system was responsible for implementation of the intervention at eight tribal primary health centres (PHC) in Pune district, India, including delivering the intervention and ensuring supplies of all commodities while KEMHRC was responsible for technical support including training of health workers, assistance in PSBI identification and management, data collection and documentation of the implementation strategy. Results A total of 175 young infants with PSBI were identified and managed. Of these, 34 had critical illness (CI), 46 had clinical severe infection (CSI) and 10 were infants aged 0-6 days with

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Section: Discussionsupporting

confidence: 87%

Feasibility of implementation of simplified management of young infants with possible serious bacterial infection when referral is not feasible in tribal areas of Pune district, Maharashtra, India

et al. 2020

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“…Efforts to implement WHO's PSBI guidelines and other newborn-focused interventions in low-resource settings should integrate local understanding of disease causations to increase demand for SYIs services from health facilities. Recent evidence on the feasibility of implementing PSBI guidelines in low-income countries have demonstrated the need for social and behavior change interventions targeting families and communities to improve careseeking from health facilities [36,37]. Strengthening community health structures by involving community health volunteers in creating awareness on the causes of illnesses and early identification in the community and referral of SYIs cases can be effective in improving community knowledge on the causes of illness in SYIs and improving care-seeking from…”

Section: Discussionmentioning

confidence: 99%

Exploring communities’ perceptions of the etiology of illnesses in newborns and young infants 0–59 days old in 4 counties in Kenya

et al. 2020

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Background Understanding communities’ beliefs about the causes of illnesses in sick young infants (SYIs) is key to strengthening interventions and improving newborn health outcomes. This study explored communities' perception of the etiology of illnesses in SYIs 0–59 days old in four counties in Kenya. Methods We used an exploratory qualitative study design. Data were collected between August and September 2018 and involved 23 in-depth interviews with female caregivers aged 15-24years; 25 focus group discussions with female caregivers aged 15–18 years, 19–24 years and 25–45 years; and 7 focus group discussions with fathers aged 18–34 years and 35 or more years. Participants were purposely sampled, only those with SYIs 0–59 days old were eligible to participate. Data were analyzed using inductive thematic analysis framework approach. Results Female caregivers and fathers attributed illnesses in SYIs 0–59 days old to natural (biomedical) and supernatural causes which sometimes co-existed. There were commonalities in perceived natural causes of illness in SYIs across sites, age groups and gender. Perceived natural causes of illness in SYIs include unfavorable environmental and hygiene conditions, poor maternal and child nutrition, and healthcare practices. Perceived supernatural causes of illness in SYIs such as ‘evil eyes’ were common across the four counties while others were geographically unique such as the belief that owls cause illnesses. Conclusion Communities’ understanding of the etiology of illnesses in SYIs in the study settings overlapped between natural and supernatural causes. There is need for child health programmes to take into consideration communities’ beliefs and practices regarding disease and health to improve newborn health outcomes.

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“…• Sub-activity 1.3: Ten postnatal home visits were to be made on days 1,3,7,14,21,28,35,42, 49 and 60 to promote optimal care practices such as breastfeeding, keeping the baby warm and hygiene; to identify danger signs in mothers and newborns, and to promote appropriate care-seeking.…”

Section: Intervention 10: Home-based Care Included 3 Sub-activitiesmentioning

confidence: 99%

“…Outpatient or community treatment is not only beneficial in terms of reduced costs but is also less disruptive for families and carries less risk of hospital-acquired infections [23]. The reasons for refusal to accept a referral to a hospital include lack of permission from concerned family members, lack of child care, religious and cultural beliefs, distance, cost of travel and treatment, concerns around quality of care and attitudes of health workers [7,[11][12][13].…”

Section: Plos Onementioning

confidence: 99%

“…The World Health Organization (WHO) recommends referral for inpatient injectable therapy for the management of PSBI in young infants (0-59 days old) [5,6]. However, in resource-limited settings, 60-80% of the families of young infants with signs of severe infection do not accept a referral to a hospital because of distance to the health facility, cost of hospitalization and cultural constraints, resulting in many preventable newborn deaths [7][8][9][10][11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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Costs and cost-effectiveness of management of possible serious bacterial infections in young infants in outpatient settings when referral to a hospital was not possible: Results from randomized trials in Africa

et al. 2021

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Introduction Serious bacterial neonatal infections are a major cause of global neonatal mortality. While hospitalized treatment is recommended, families cannot access inpatient treatment in low resource settings. Two parallel randomized control trials were conducted at five sites in three countries (Democratic Republic of Congo, Kenya, and Nigeria) to compare the effectiveness of treatment with experimental regimens requiring fewer injections with a reference regimen A (injection gentamicin plus injection procaine penicillin both once daily for 7 days) on the outpatient basis provided to young infants (0–59 days) with signs of possible serious bacterial infection (PSBI) when the referral was not feasible. Costs were estimated to quantify the financial implications of scaleup, and cost-effectiveness of these regimens. Methods Direct economic costs (including personnel, drugs and consumable costs) were estimated for identification, prenatal and postnatal visits, assessment, classification, treatment and follow-up. Data on time spent by providers on each activity was collected from 83% of providers. Indirect marginal financial costs were estimated for non-consumables/capital, training, transport, communication, administration and supervision by considering only a share of the total research and health system costs considered important for the program. Total economic costs (direct plus indirect) per young infant treated were estimated based on 39% of young infants enrolled in the trial during 2012 and the number of days each treated during one year. The incremental cost-effectiveness ratio was calculated using treatment failure after one week as the outcome indicator. Experimental regimens were compared to the reference regimen and pairwise comparisons were also made. Results The average costs of treating a young infant with clinical severe infection (a sub-category of PSBI) in 2012 was lowest with regimen D (injection gentamicin once daily for 2 days plus oral amoxicillin twice daily for 7 days) at US$ 20.9 (95% CI US$ 16.4–25.3) or US$ 32.5 (2018 prices). While all experimental regimens B (injection gentamicin once daily plus oral amoxicillin twice daily, both for 7 days), regimen C (once daily of injection gentamicin injection plus injection procaine penicillin for 2 days, thereafter oral amoxicillin twice daily for 5 days) and regimen D were found to be more cost-effective as compared with the reference regimen A; pairwise comparison showed regimen D was more cost-effective than B or C. For fast breathing, the average cost of treatment with regimen E (oral amoxicillin twice daily for 7 days) at US$ 18.3 (95% CI US$ 13.4–23.3) or US$ 29.0 (2018 prices) was more cost-effective than regimen A. Indirect costs were 32% of the total treatment costs. Conclusion Scaling up of outpatient treatment for PSBI when the referral is not feasible with fewer injections and oral antibiotics is cost-effective for young infants and can lead to increased access to treatment resulting in potential reductions in neonatal mortality. Clinical trial registration The trial was registered with Australian New Zealand Clinical Trials Registry under ID ACTRN 12610000286044.

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Caregiver acceptability of the guidelines for managing young infants with possible serious bacterial infections (PSBI) in primary care facilities in rural Bangladesh

Cited by 25 publications

References 47 publications

Feasibility of implementation of simplified management of young infants with possible serious bacterial infection when referral is not feasible in tribal areas of Pune district, Maharashtra, India

Feasibility of implementation of simplified management of young infants with possible serious bacterial infection when referral is not feasible in tribal areas of Pune district, Maharashtra, India

Exploring communities’ perceptions of the etiology of illnesses in newborns and young infants 0–59 days old in 4 counties in Kenya

Costs and cost-effectiveness of management of possible serious bacterial infections in young infants in outpatient settings when referral to a hospital was not possible: Results from randomized trials in Africa

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