Causes of Neonatal Deaths in a Rural Subdistrict of Bangladesh: Implications for Intervention

Chowdhury, Hafizur Rahman; Thompson, Sandra; Ali, Mohammed; Alam, Nurul; Yunus, Muhammad; Streatfield, Peter Kim

doi:10.3329/jhpn.v28i4.6044

Cited by 76 publications

(86 citation statements)

References 24 publications

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“…3 Most neonatal deaths occur within the first week of life. 4 An estimated 35.1% of neonatal deaths are caused by prematurity, 23.3% by intrapartumrelated complications (birth asphyxia), and 26.9% by infection-related causes (sepsis/meningitis, pneumonia, tetanus, and diarrhea). 3 An important component of reducing maternal mortality and morbidity and intrapartum-related neonatal deaths is to increase the availability, quality, and demand for skilled care at birth.…”

Section: Introductionmentioning

confidence: 99%

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Wichaidit

Alam

Halder

et al. 2016

The American Society of Tropical Medicine and Hygiene

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Abstract. Bangladesh's maternal mortality and neonatal mortality remain unacceptably high. We assessed the availability and quality of emergency obstetric care (EmOC) and emergency newborn care (EmNC) services at health facilities in Bangladesh. We randomly sampled 50 rural villages and 50 urban neighborhoods throughout Bangladesh and interviewed the director of eight and nine health facilities nearest to each sampled area. We categorized health facilities into different quality levels (high, moderate, low, and substandard) based on staffing, availability of a phone or ambulance, and signal functions (six categories for EmOC and four categories for EmNC). We interviewed the directors of 875 health facilities. Approximately 28% of health facilities did not have a skilled birth attendant on call 24 hours per day. The least commonly performed EmOC signal function was administration of anticonvulsants (67%). The quality of EmOC services was high in 33% and moderate in 52% of the health facilities. The least common EmNC signal function was kangaroo mother care (7%). The quality of EmNC was high in 2% and moderate in 33% of the health facilities. Approximately one-third of health facilities lack 24-hour availability of skilled birth attendants, increasing the risk of peripartum complications. Most health facilities offered moderate to high quality services for EmOC and low to substandard quality for EmNC.

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Section: Introductionmentioning

confidence: 99%

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Wichaidit

Alam

Halder

et al. 2016

The American Society of Tropical Medicine and Hygiene

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“…This finding suggests the use of methylene blue as a new treatment to prevent or decrease retinal damage in the context of ischemic proliferative retinopathy. retina; nitric oxide; ischemic proliferative retinopathy; methylene blue; angiogenesis PERINATAL ASPHYXIA (PA) is one of the most severe problems in perinatology services across the world (9,15,23,27). PA generates a transient global hypoxia-ischemia status that damages the brain, spinal cord, and retina (14, 17, 39, 52).…”

mentioning

confidence: 99%

Methylene blue prevents retinal damage in an experimental model of ischemic proliferative retinopathy

Rey-Funes

Larráyoz

Fernández

et al. 2016

American Journal of Physiology-Regulatory, Integrative and Comp

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-Perinatal asphyxia induces retinal lesions, generating ischemic proliferative retinopathy, which may result in blindness. Previously, we showed that the nitrergic system was involved in the physiopathology of perinatal asphyxia. Here we analyze the application of methylene blue, a well-known soluble guanylate cyclase inhibitor, as a therapeutic strategy to prevent retinopathy. Male rats (n ϭ 28 per group) were treated in different ways: 1) control group comprised born-to-term animals; 2) methylene blue group comprised animals born from pregnant rats treated with methylene blue (2 mg/kg) 30 and 5 min before delivery; 3) perinatal asphyxia (PA) group comprised rats exposed to perinatal asphyxia (20 min at 37°C); and 4) methylene blue-PA group comprised animals born from pregnant rats treated with methylene blue (2 mg/kg) 30 and 5 min before delivery, and then the pups were subjected to PA as above. For molecular studies, mRNA was obtained at different times after asphyxia, and tissue was collected at 30 days for morphological and biochemical analysis. Perinatal asphyxia produced significant gliosis, angiogenesis, and thickening of the inner retina. Methylene blue treatment reduced these parameters. Perinatal asphyxia resulted in a significant elevation of the nitrergic system as shown by NO synthase (NOS) activity assays, Western blotting, and (immuno)histochemistry for the neuronal isoform of NOS and NADPH-diaphorase activity. All these parameters were also normalized by the treatment. In addition, methylene blue induced the upregulation of the anti-angiogenic peptide, pigment epithelium-derived factor. Application of methylene blue reduced morphological and biochemical parameters of retinopathy. This finding suggests the use of methylene blue as a new treatment to prevent or decrease retinal damage in the context of ischemic proliferative retinopathy. retina; nitric oxide; ischemic proliferative retinopathy; methylene blue; angiogenesis PERINATAL ASPHYXIA (PA) is one of the most severe problems in perinatology services across the world (9,15,23,27). PA generates a transient global hypoxia-ischemia status that damages the brain, spinal cord, and retina (14, 17, 39, 52). The degree and the length of perinatal asphyxia are decisive for the development of injury sequelae, such as attention-deficit hyperactivity disorder (1), epilepsy, mental retardation, spasticity, and visual or hearing alterations (61). One third of asphyctic neonates develop serious long-term neurological injuries including several degrees of ischemic proliferative retinopathy (IPR) and even blindness (20).In rats, the retina is particularly sensitive to oxygen alterations (56), and the morphological changes observed in its inner layers are compatible with some alterations observed in human diseases such as retinopathy in diabetes, retinal vein occlusion, and retinopathy of prematurity (ROP), an avoidable cause of visual impairment and blindness in children (20, 61). The changes observed in asphyctic animals include ganglion cell degeneration, n...

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“…Among them, 39 were in the OPD group and 27 in the IPD group. A total of seven patients were excluded (OPD 2 and IPD 5) due to reasons such as lost to follow-up (4), left against medical advice (LAMA) (1), death (1) and referred to a higher centre (1). Finally, data were analysed for 59 neonates (OPD 37 and IPD 22) (figure 1).…”

Section: Resultsmentioning

confidence: 99%

“…It is reported that sepsis and pneumonia were the causes of death in 27% of newborns. 1 The early and efficient diagnosis of neonatal sepsis remains a difficult task due to delayed development of signs and symptoms. Early diagnosis and treatment with suitable antibiotics are usually started in hospital.…”

Section: Introductionmentioning

confidence: 99%

Continuation of Indoor Prescribed Antibiotics in the Outpatient Treatment of Neonatal Sepsis

Islam¹,

Talukder²,

Akter³

2017

Bangladesh Med Res Counc Bull

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Neonatal sepsis is a common problem whose antibiotic treatment is usually recommended whilst admitted in hospital for at least 10-14 days. Families in Bangladesh however are reluctant to stay in hospital to complete the treatment for such a long time due to reasons such as financial difficulties and either or both are working parents. This leads to incomplete treatment of neonatal sepsis. We hypothesised that after initial improvement in neonatal sepsis with injectable antibiotics whilst admitted, the same treatment could be safely continued in the outpatient setting to complete the full course. This intervention study was carried out in 66 newborns (0-28 days) recruited at the time of admission with suspected sepsis in the Department of Paediatrics, Centre for Woman and Child Health (CWCH), Dhaka. After investigations, treatment was initiated with injectable antibiotics according to clinical diagnosis and severity. Families who agreed to stay and complete the treatment as inpatient were given the complete course of antibiotics in hospital as IPD group and those who wanted to shorten their stay in hospital, were discharged with injectable antibiotics and follow-up in the outpatient department as OPD group. Data were analysed on 59 neonates, 37 in the OPD and 22 in the IPD group, admitted to hospital between April 2014 and December 2015. There were no readmissions or complications in either group, but one newborn died in the IPD group. Cure rate was 100% in both OPD and IPD groups. Average duration of hospital stay was 3.95±1.76 days and 6.14±2.99 days in the OPD and IPD groups respectively. Treatment cost per patient was 5,823±3,752 Bangladesh Taka (BDT) and 7,082±6,520 BDT in the OPD and IPD groups respectively. Findings of this study suggest that early discharge with injectable antibiotics as an outpatient is a safe and cost effective option for neonatal sepsis.

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Causes of Neonatal Deaths in a Rural Subdistrict of Bangladesh: Implications for Intervention

Cited by 76 publications

References 24 publications

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Availability and Quality of Emergency Obstetric and Newborn Care in Bangladesh

Methylene blue prevents retinal damage in an experimental model of ischemic proliferative retinopathy

Continuation of Indoor Prescribed Antibiotics in the Outpatient Treatment of Neonatal Sepsis

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