Validation of community health workers' assessment of neonatal illness in rural Bangladesh

Abstract

ResearchObjective To estimate the validity (sensitivity, specificity, and positive and negative predictive values) of a clinical algorithm as used by community health workers (CHWs) to detect and classify neonatal illness during routine household visits in rural Bangladesh. Methods CHWs evaluated breastfeeding and symptoms and signs of illness in 395 neonates selected randomly from neonatal illness surveillance during household visits on postnatal days 0, 2, 5 and 8. Neonates classified with very severe disease (VSD) were referred to a community-based hospital. Within 12 hours of CHW assessments, physicians independently evaluated all neonates seen in a given day by one CHW, randomly chosen from among 36 project CHWs. Physicians recorded symptoms and signs of illness, classified the illness, and determined whether the newborn needed referral-level care at the hospital. Physicians' identification and classification were used as the gold standard in determining the validity of CHWs' identification of symptoms and signs of illness and its classification. Findings CHWs' classification of VSD showed a sensitivity of 73%, a specificity of 98%, a positive predictive value of 57% and a negative predictive value of 99%. A maternal report of any feeding problem as ascertained by physician questioning was significantly associated (P < 0.001) with "not sucking at all" and "not attached at all" or "not well attached" as determined clinically by CHWs during feeding assessment. Conclusion CHWs identified with high validity the neonates with severe illness needing referral-level care. Home-based illness recognition and management, including referral of neonates with severe illness by CHWs, is a promising strategy for improving neonatal health and survival in low-resource developing country settings.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.

Pattern and outcome of admissions in a neonatal high dependency unit of a medical college hospital in Khulna, Bangladesh

“…19,20 In this study, LBW was found in 14.1% of patients which is similar to another study conducted in Bangladesh they found LBW 13.3% among their patients. 21 The incidence of LBW was 39.0% in a study conducted in Pakistan, 20.0% in India, and 11.0% in an Ethiopian one. [22][23][24][25] Birth asphyxia accounted for 11.1% of the admissions in this study.…”

Population-based Incidence and Etiology of Community-acquired Neonatal Viral Infections in Bangladesh

“…CHWs assessed neonates at home on postnatal days 0, 2, 5 and 8, identified the presence of illness and made referrals to Kumudini Hospital according to a validated clinical algorithm based on the presence of clinical signs and parental reports of symptoms. 7,[15][16][17] For referred neonates, the CHWs facilitated transportation, and all care at the hospital was free. Detailed information on the study design and interventions 15,17 and CHW characteristics 7 is presented elsewhere.…”

“…[2][3][4] In high-mortality settings, serious infections cause up to 50% of neonatal deaths. 5,6 Although infections cause >1000 neonatal deaths every day, 3,7 the causes and patterns of community-acquired neonatal infections have not been adequately investigated in developing countries, where estimates are derived primarily from hospital-based studies, 8,9 even though more than one-half of newborns who die in low-income countries like Bangladesh do so at home. 10 In 2009, we reported the incidence of community-acquired neonatal bacteremia in Bangladesh based on population-based surveillance.…”

Does the Availability of Community Health Worker/Mobile-Health Van Unit within the Community Impacts Neonatal Survival?

“…Darmstadt [8] refer neonates born at home and requiring specialized treatment. Some of these trained community health workers were so efficient that they could manage sick neonates by themselves.…”