Managing possible serious bacterial infection of young infants where referral is not possible: Lessons from the early implementation experience in Kushtia District learning laboratory, Bangladesh

Abstract

Background Serious infections account for 25% of global newborn deaths annually, most in lowresource settings where hospital-based treatment is not accessible or feasible. In Bangladesh, one-third of neonatal deaths are attributable to serious infection; in 2014, the government adopted new policy for outpatient management of danger signs indicating possible serious bacterial infections (PSBI) when referral was not possible. We conducted implementation research to understand what it takes for a district health team to implement quality outpatient PSBI management per national guidelines. Methods PSBI management was introduced as part of the Comprehensive Newborn Care Package in 2015. The study piloted this package through government health systems with limited partner support to inform scale-up efforts. Data collection included facility register reviews for cases seen at primary level facilities; facility readiness and provider knowledge and skills assessments; household surveys capturing caregiver knowledge of newborn danger signs and care-seeking for newborn illness; and follow-up case tracking, capturing treatment adherence and outcomes. Analysis consisted of descriptive statistics.

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

“…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.…”

“…In the Malawi study, out of 150 young infants with FB, cure rate was achieved in 96% infants [27]. The study in Kushtia, Bangladesh reported that among 475 young infants with FB, approximately 80% of caregivers reported that their infant had received oral amoxicillin for five days and 74% for seven days and the treatment failure rate was approximately 5% [26]. Similar proportions were reported in the Nigeria study with All 7-59 days old young infants with fast breathing who received treatment at the outpatient improved with oral amoxicillin [28].…”

Management of possible serious bacterial infection in young infants closer to home when referral is not feasible: Lessons from implementation research in Himachal Pradesh, India

“…Coverage of our treatment was lower than that reported by the study in Zaria, Nigeria (96%) [23] but was higher than those reported from Malawi (64%) [24], Pune, India (57%) [25], Lucknow, India (53%) [26], Kushtia, Bangladesh (31%) [27]. Like our study, high treatment completion rates in infants with CSI treated on an outpatient basis were also reported by Malawi (95%) [24], Zaria, Nigeria (94%) [23] and MaMoni project, Bangladesh (80%) [28].…”

“…A large proportion of PSBI cases can be identified if families and community workers are taught to recognise illness and seek care early from an appropriate source; 80% of the estimated PSBI cases in the study area were identified, assuming 10% of infants would have sepsis [ 22 ]. Our 21% proportion of fast breathing pneumonia in 7–59 day-old infants was lower compared to 87% in Kushtia, Bangladesh [ 27 ], 49% in Pune, India [ 25 ], 27% in MaMoni project, Bangladesh [ 29 ], 28% in Malawi [ 24 ], 22% in Zaria, Nigeria [ 23 ] and higher compared to 13.3% in Lucknow, India [ 26 ]. Though it is possible that some cases of PSBI were missed, however, an examination of the deaths reported in the state government portal, showed that of the 69 deaths among infants aged 0–59 days reported during the study period ~14 were due to probable sepsis.…”

“…Adherence to the advised treatment was fairly high, which shows that the families had confidence in the treatment and that the infants improved with it. Other PSBI implementation research sites from Kushtia [ 27 ] and MaMoni [ 29 ] in Bangladesh, Ntcheu [ 24 ] in Malawi and Zaria [ 23 ] in Nigeria also reported high adherence rate; whereas in Lucknow [ 26 ], India it was lower [ 23 – 24 , 26 – 27 , 29 ].…”