Implementation research to increase treatment coverage of possible serious bacterial infections in young infants when a referral is not feasible: lessons learnt

Authors

Shabina Ariff, Aga Khan UniversityFollow
Sajid Bashir Soofi, Aga Khan UniversityFollow
Zamir Suhag, Aga Khan UniversityFollow
Suhail Chanar, Aga Khan University
Maria Asif Bhura, Aga Khan UniversityFollow
Zaib Dahar, People's Primary Healthcare Initiative, Sindh, Pakistan
Imran Ahmed, Aga Khan UniversityFollow
Ali Turab, Aga Khan University
Atif Habib, Aga Khan UniversityFollow
Yasir Bin Nisar, World Health Organization, Geneva, Switzerland.
Zulfiqar Ahmed Bhutta, Aga Khan UniversityFollow

Document Type

Article

Department

Paediatrics and Child Health; Centre of Excellence in Women and Child Health

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.
Keywords: basic health unit; implementation research; lady health worker; possible serious bacterial infection; sick young infants; simplified antibiotic regimens.

Comments

Volume, issue and Pagination are not provided by the author/publisher

Publication (Name of Journal)

Journal of public health (Oxford, England)

Recommended Citation

Ariff, S., Soofi, S. B., Suhag, Z., Chanar, S., Bhura, M. A., Dahar, Z., Ahmed, I., Turab, A., Habib, A., Nisar, Y. B., Bhutta, Z. A. (2022). Implementation research to increase treatment coverage of possible serious bacterial infections in young infants when a referral is not feasible: lessons learnt. Journal of public health (Oxford, England).
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_women_childhealth_paediatr/1123