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Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh

Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0–59 days) with simpler antibiotic regimens if hospital referral is not feasible. Bangladesh was one of the first countries...

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Autores principales: Applegate, Jennifer A, Ahmed, Sabbir, Khan, Marufa Aziz, Alam, Sanjida, Kabir, Nazmul, Islam, Munia, Bhuiyan, Mamun, Islam, Jahurul, Rashid, Iftekhar, Wall, Steve, de Graft-Johnson, Joseph, Baqui, Abdullah H, George, Joby
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882554/
https://www.ncbi.nlm.nih.gov/pubmed/31803507
http://dx.doi.org/10.1136/bmjgh-2019-001643
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author Applegate, Jennifer A
Ahmed, Sabbir
Khan, Marufa Aziz
Alam, Sanjida
Kabir, Nazmul
Islam, Munia
Bhuiyan, Mamun
Islam, Jahurul
Rashid, Iftekhar
Wall, Steve
de Graft-Johnson, Joseph
Baqui, Abdullah H
George, Joby
author_facet Applegate, Jennifer A
Ahmed, Sabbir
Khan, Marufa Aziz
Alam, Sanjida
Kabir, Nazmul
Islam, Munia
Bhuiyan, Mamun
Islam, Jahurul
Rashid, Iftekhar
Wall, Steve
de Graft-Johnson, Joseph
Baqui, Abdullah H
George, Joby
author_sort Applegate, Jennifer A
collection PubMed
description Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0–59 days) with simpler antibiotic regimens if hospital referral is not feasible. Bangladesh was one of the first countries to adapt WHO guidance into national guidelines for implementation in primary healthcare facilities. Early implementation was led by the Ministry of Health and Family Welfare (MOHFW) in 10 subdistricts of Bangladesh with support from USAID’s MaMoni Health System Strengthening project. This mixed methods implementation research case study explores programme feasibility and acceptability through analysis of service delivery data from 4590 sick young infants over a 15-month period, qualitative interviews with providers and MOHFW managers and documentation by project staff. Multistakeholder collaboration was key to ensuring facility readiness and feasibility of programme delivery. For the 514 (11%) infants classified as PSBI, provider adherence to prereferral treatment and follow-up varied across infection subcategories. Many clinical severe infection cases for whom referral was not feasible received the recommended two doses of injectable gentamicin and follow-up, suggesting delivery of simplified antibiotic treatment is feasible. However, prereferral antibiotic treatment was low for infants whose families accepted hospital referral, which highlights the need for additional focus on managing these cases in training and supervision. Systems for tracking sick infants that accept hospital referral are needed, and follow-up of all PSBI cases requires strengthening to ensure sick infants receive the recommended treatment, to monitor outcomes and assess the effectiveness of the programme. Only 11.2% (95% CI 10.3 to 12.1) of the expected PSBI cases sought care from the selected service delivery points in the programme period. However, increasing trends in utilisation suggest improved awareness and acceptability of services among families of young infants as the programme matured. Future programme activities should include interviews with caregivers to explore the complexities around referral feasibility and acceptability of simplified antibiotic treatment.
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spelling pubmed-68825542019-12-04 Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh Applegate, Jennifer A Ahmed, Sabbir Khan, Marufa Aziz Alam, Sanjida Kabir, Nazmul Islam, Munia Bhuiyan, Mamun Islam, Jahurul Rashid, Iftekhar Wall, Steve de Graft-Johnson, Joseph Baqui, Abdullah H George, Joby BMJ Glob Health Practice Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0–59 days) with simpler antibiotic regimens if hospital referral is not feasible. Bangladesh was one of the first countries to adapt WHO guidance into national guidelines for implementation in primary healthcare facilities. Early implementation was led by the Ministry of Health and Family Welfare (MOHFW) in 10 subdistricts of Bangladesh with support from USAID’s MaMoni Health System Strengthening project. This mixed methods implementation research case study explores programme feasibility and acceptability through analysis of service delivery data from 4590 sick young infants over a 15-month period, qualitative interviews with providers and MOHFW managers and documentation by project staff. Multistakeholder collaboration was key to ensuring facility readiness and feasibility of programme delivery. For the 514 (11%) infants classified as PSBI, provider adherence to prereferral treatment and follow-up varied across infection subcategories. Many clinical severe infection cases for whom referral was not feasible received the recommended two doses of injectable gentamicin and follow-up, suggesting delivery of simplified antibiotic treatment is feasible. However, prereferral antibiotic treatment was low for infants whose families accepted hospital referral, which highlights the need for additional focus on managing these cases in training and supervision. Systems for tracking sick infants that accept hospital referral are needed, and follow-up of all PSBI cases requires strengthening to ensure sick infants receive the recommended treatment, to monitor outcomes and assess the effectiveness of the programme. Only 11.2% (95% CI 10.3 to 12.1) of the expected PSBI cases sought care from the selected service delivery points in the programme period. However, increasing trends in utilisation suggest improved awareness and acceptability of services among families of young infants as the programme matured. Future programme activities should include interviews with caregivers to explore the complexities around referral feasibility and acceptability of simplified antibiotic treatment. BMJ Publishing Group 2019-11-19 /pmc/articles/PMC6882554/ /pubmed/31803507 http://dx.doi.org/10.1136/bmjgh-2019-001643 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Practice
Applegate, Jennifer A
Ahmed, Sabbir
Khan, Marufa Aziz
Alam, Sanjida
Kabir, Nazmul
Islam, Munia
Bhuiyan, Mamun
Islam, Jahurul
Rashid, Iftekhar
Wall, Steve
de Graft-Johnson, Joseph
Baqui, Abdullah H
George, Joby
Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh
title Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh
title_full Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh
title_fullStr Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh
title_full_unstemmed Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh
title_short Early implementation of guidelines for managing young infants with possible serious bacterial infection in Bangladesh
title_sort early implementation of guidelines for managing young infants with possible serious bacterial infection in bangladesh
topic Practice
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6882554/
https://www.ncbi.nlm.nih.gov/pubmed/31803507
http://dx.doi.org/10.1136/bmjgh-2019-001643
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