孟加拉国农村地区社区卫生工作者对新生儿感染进行居家管理的效果
Effectiveness of home-based management of newborn infections by community health workers in rural Bangladesh.
作者信息
Baqui Abdullah H, Arifeen Shams E, Williams Emma K, Ahmed Saifuddin, Mannan Ishtiaq, Rahman Syed M, Begum Nazma, Seraji Habibur R, Winch Peter J, Santosham Mathuram, Black Robert E, Darmstadt Gary L
机构信息
International Center for Advancing Neonatal Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
出版信息
Pediatr Infect Dis J. 2009 Apr;28(4):304-10. doi: 10.1097/INF.0b013e31819069e8.
BACKGROUND
: Infections account for about half of neonatal deaths in low-resource settings. Limited evidence supports home-based treatment of newborn infections by community health workers (CHW).
METHODS
: In one study arm of a cluster randomized controlled trial, CHWs assessed neonates at home, using a 20-sign clinical algorithm and classified sick neonates as having very severe disease or possible very severe disease. Over a 2-year period, 10,585 live births were recorded in the study area. CHWs assessed 8474 (80%) of the neonates within the first week of life and referred neonates with signs of severe disease. If referral failed but parents consented to home treatment, CHWs treated neonates with very severe disease or possible very severe disease with multiple signs, using injectable antibiotics.
RESULTS
: For very severe disease, referral compliance was 34% (162/478 cases), and home treatment acceptance was 43% (204/478 cases). The case fatality rate was 4.4% (9/204) for CHW treatment, 14.2% (23/162) for treatment by qualified medical providers, and 28.5% (32/112) for those who received no treatment or who were treated by other unqualified providers. After controlling for differences in background characteristics and illness signs among treatment groups, newborns treated by CHWs had a hazard ratio of 0.22 (95% confidence interval [CI] = 0.07-0.71) for death during the neonatal period and those treated by qualified providers had a hazard ratio of 0.61 (95% CI = 0.37-0.99), compared with newborns who received no treatment or were treated by untrained providers. Significantly increased hazards ratios of death were observed for neonates with convulsions (hazard ratio [HR] = 6.54; 95% CI = 3.98-10.76), chest in-drawing (HR = 2.38, 95% CI = 1.29-4.39), temperature <35.3 degrees C (HR = 3.47, 95% CI = 1.30-9.24), and unconsciousness (HR = 7.92, 95% CI = 3.13-20.04).
CONCLUSIONS
: Home treatment of very severe disease in neonates by CHWs was effective and acceptable in a low-resource setting in Bangladesh.
背景
在资源匮乏地区，感染约占新生儿死亡原因的一半。社区卫生工作者（CHW）对新生儿感染进行居家治疗的证据有限。
方法
在一项整群随机对照试验的一个研究组中，社区卫生工作者使用包含20项体征的临床算法在家中对新生儿进行评估，并将患病新生儿分类为患有极重度疾病或可能患有极重度疾病。在两年期间，研究区域记录了10585例活产。社区卫生工作者在新生儿出生后第一周内对8474例（80%）新生儿进行了评估，并转诊有严重疾病体征的新生儿。如果转诊失败但家长同意居家治疗，社区卫生工作者会使用注射用抗生素对患有极重度疾病或可能患有极重度疾病且有多种体征的新生儿进行治疗。
结果
对于极重度疾病，转诊依从率为34%（162/478例），居家治疗接受率为43%（204/478例）。社区卫生工作者治疗的病死率为4.4%（9/204），合格医疗提供者治疗的病死率为14.2%（23/162），未接受治疗或由其他不合格提供者治疗的病死率为28.5%（32/112）。在控制了各治疗组背景特征和疾病体征的差异后，与未接受治疗或由未经培训的提供者治疗的新生儿相比，社区卫生工作者治疗的新生儿在新生儿期死亡的风险比为0.22（95%置信区间[CI]=0.07 - 0.71），合格提供者治疗的新生儿死亡风险比为0.61（95%CI = 0.37 - 0.99）。惊厥（风险比[HR]=6.54；95%CI = 3.98 - 10.76）、胸廓凹陷（HR = 2.38，95%CI = 1.29 - 4.39）、体温<35.3摄氏度（HR = 3.47，95%CI = 1.30 - 9.24）和昏迷（HR = 7.92，95%CI = 3.13 - 20.04）的新生儿死亡风险比显著增加。
结论
在孟加拉国的一个资源匮乏地区，社区卫生工作者对新生儿极重度疾病进行居家治疗是有效且可接受的。
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