Health Systems Research Unit, Medical Research Council, 491 Ridge Road, Durban, South Africa.
BMC Health Serv Res. 2013 Feb 6;13:47. doi: 10.1186/1472-6963-13-47.
Globally, 40% of the 7.6 million deaths of children under five every year occur in the neonatal period (first 28 days after birth). Increased and earlier recognition of illness facilitated by community health workers (CHWs), coupled with effective referral systems can result in better child health outcomes. This model has not been tested in a peri-urban poor setting in Africa, or in a high HIV context.
The Good Start Saving Newborn Lives (SNL) study (ISRCTN41046462) conducted in Umlazi, KwaZulu-Natal, was a community randomized trial to assess the effect of an integrated home visit package delivered to mothers by CHWs during pregnancy and post-delivery on uptake of PMTCT interventions and appropriate newborn care practices. CHWs were trained to refer babies with illnesses or identified danger signs. The aim of this sub-study was to assess the effectiveness of this referral system by describing CHW referral completion rates as well as mothers' health-care seeking practices. Interviews were conducted using a structured questionnaire with all mothers whose babies had been referred by a CHW since the start of the SNL trial. Descriptive analysis was conducted to describe referral completion and health seeking behaviour of mothers.
Of the 2423 women enrolled in the SNL study, 148 sick infants were referred between June 2008 and June 2010. 62% of referrals occurred during the first 4 weeks of life and 22% between birth and 2 weeks of age. Almost all mothers (95%) completed the referral as advised by CHWs. Difficulty breathing, rash and redness/discharge around the cord accounted for the highest number of referrals (26%, 19% and 17% respectively). Only16% of health workers gave written feedback on the outcome of the referral to the referring CHW.
We found high compliance with CHW referral of sick babies in an urban South African township. This suggests that CHWs can play a significant role, within community outreach teams, to improve newborn health and reduce child mortality. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health which involves the establishment of family health worker teams including CHWs.
ISRCTN41046462.
每年全球有 760 万五岁以下儿童死亡，其中 40%发生在新生儿期（出生后 28 天内）。社区卫生工作者（CHW）可以更早地识别疾病并提供帮助，加上有效的转介系统，可以改善儿童的健康结局。这种模式尚未在非洲的城市周边贫困地区或高 HIV 环境中进行测试。
Good Start Saving Newborn Lives (SNL) 研究（ISRCTN41046462）在夸祖鲁-纳塔尔省的乌姆拉齐进行，这是一项社区随机试验，旨在评估 CHW 在妊娠和产后期间为母亲提供的综合家访套餐对 PMTCT 干预措施和适当的新生儿护理实践的影响。CHW 接受了培训，以便在婴儿出现疾病或出现危险症状时进行转介。这项子研究的目的是通过描述 CHW 的转介完成率以及母亲的医疗保健寻求行为来评估该转介系统的有效性。对自 SNL 试验开始以来，所有被 CHW 转介的婴儿的母亲进行了使用结构化问卷的访谈。采用描述性分析方法来描述转介完成情况和母亲的医疗保健寻求行为。
在参加 SNL 研究的 2423 名妇女中，2008 年 6 月至 2010 年 6 月期间有 148 名患病婴儿被转介。62%的转介发生在出生后 4 周内，22%发生在出生后 2 周内。几乎所有母亲（95%）都按照 CHW 的建议完成了转介。呼吸困难、皮疹和脐带周围发红/分泌物占转介的最高比例（分别为 26%、19%和 17%）。只有 16%的卫生工作者将转介的结果书面反馈给转介的 CHW。
我们发现，在南非城市郊区，CHW 对患病婴儿的转介具有很高的依从性。这表明，CHW 可以在社区外展团队中发挥重要作用，改善新生儿健康并降低儿童死亡率。这支持了南非国家卫生部目前正在进行的初级卫生保健改革进程，该进程涉及建立包括 CHW 在内的家庭卫生工作者团队。
ISRCTN41046462。
