학술논문
Implementation research to increase treatment coverage of possible serious bacterial infections in young infants when a referral is not feasible: lessons learnt.
Document Type
Academic Journal
Author
Ariff S; Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.; Soofi SB; Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.; Centre of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan.; Suhag Z; People's Primary Healthcare Initiative, Sindh, Pakistan.; Chanar S; Centre of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan.; Bhura M; Centre of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan.; Dahar Z; People's Primary Healthcare Initiative, Sindh, Pakistan.; Ahmed I; Centre of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan.; Turab A; Centre of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan.; Habib A; Centre of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan.; Nisar YB; Department of Maternal Newborn Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland.; Aboubaker S; Department of Maternal Newborn Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland.; Wall S; Saving Newborn Lives, Save the Children, Washington DC, USA.; Soomro AW; People's Primary Healthcare Initiative, Sindh, Pakistan.; Qazi SA; Former WHO Staff, Geneva, Switzerland.; Bahl R; Department of Maternal Newborn Child, Adolescent Health and Aging, World Health Organization, Geneva, Switzerland.; Bhutta ZA; Centre of Excellence in Women & Child Health, Aga Khan University, Karachi, Pakistan.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 101188638 Publication Model: Print Cited Medium: Internet ISSN: 1741-3850 (Electronic) Linking ISSN: 17413842 NLM ISO Abbreviation: J Public Health (Oxf) Subsets: MEDLINE
Subject
Language
English
Abstract
Background: The objective was to achieve high coverage of possible serious bacterial infections (PSBI) treatment using the World Health Organization (WHO) guideline for managing it on an outpatient basis when referral to a hospital is not feasible.
Methods: We implemented this guideline in the programme settings at 10 Basic Health Units (BHU) in two rural districts of Sindh in Pakistan using implementation research. A Technical Support Unit supported the programme to operationalize guidelines, built capacity of health workers through training, monitored their clinical skills, mentored them and assured quality. The community-based health workers visited households to identify sick infants and referred them to the nearest BHU for further management. The research team collected data.
Results: Of 17 600 identified livebirths, 1860 young infants with any sign of PSBI sought care at BHUs and 1113 (59.8%) were brought by families. We achieved treatment coverage of 95%, assuming an estimated 10% incidence of PSBI in the first 2 months of life and that 10% of young infants came from outside the study catchment area. All 923 infants (49%; 923/1860) 7-59 days old with only fast breathing (pneumonia) treated with outpatient oral amoxicillin were cured. Hospital referral was refused by 83.4% (781/937) families who accepted outpatient treatment; 92.2% (720/781) were cured and 0.8% (6/781) died. Twelve (7.6%; 12/156) died among those treated in a hospital.
Conclusion: It is feasible to achieve high coverage by implementing WHO PSBI management guidelines in a programmatic setting when a referral is not feasible.
(© The Author(s) 2022. Published by Oxford University Press on behalf of Faculty of Public Health.)
Methods: We implemented this guideline in the programme settings at 10 Basic Health Units (BHU) in two rural districts of Sindh in Pakistan using implementation research. A Technical Support Unit supported the programme to operationalize guidelines, built capacity of health workers through training, monitored their clinical skills, mentored them and assured quality. The community-based health workers visited households to identify sick infants and referred them to the nearest BHU for further management. The research team collected data.
Results: Of 17 600 identified livebirths, 1860 young infants with any sign of PSBI sought care at BHUs and 1113 (59.8%) were brought by families. We achieved treatment coverage of 95%, assuming an estimated 10% incidence of PSBI in the first 2 months of life and that 10% of young infants came from outside the study catchment area. All 923 infants (49%; 923/1860) 7-59 days old with only fast breathing (pneumonia) treated with outpatient oral amoxicillin were cured. Hospital referral was refused by 83.4% (781/937) families who accepted outpatient treatment; 92.2% (720/781) were cured and 0.8% (6/781) died. Twelve (7.6%; 12/156) died among those treated in a hospital.
Conclusion: It is feasible to achieve high coverage by implementing WHO PSBI management guidelines in a programmatic setting when a referral is not feasible.
(© The Author(s) 2022. Published by Oxford University Press on behalf of Faculty of Public Health.)