Satpathy Radhanath, Nanda Pritish, Nanda Nimai C, Bal Himadri B, Mohanty Ranjita, Mishra Archana, Swain Tapoja, Pradhan Keshab C, Panigrahi Kalpana, Dutta Ambarish, Misra Pravas R, Parida Sailajanandan, Panigrahi Pinaki
From the *Asian Institute of Public Health, Bhubaneswar, Odisha, India; †Ispat General Hospital, Rourkela, Odisha, India; ‡Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska; and §Sri Ramachandra Bhanj Medical College, Cuttack, Odisha, India.
Pediatr Infect Dis J. 2016 May;35(5 Suppl 1):S74-8. doi: 10.1097/INF.0000000000001112.
The Aetiology of Neonatal Infection in South Asia (ANISA) study is being carried out at 5 sites across Bangladesh, India and Pakistan, generating in-depth information on etiologic agents in the community setting. Pregnancies are identified, births are registered and young infants are followed up to 59 days old with regular assessments for possible serious bacterial infection following a generic protocol. Specimens are collected from suspected cases. This article describes the challenges in implementing the generic ANISA protocol and modifications made to accommodate the Odisha site, India.
Primary challenges in implementing the protocol are the large geographic area, with a population of over 350,000, to be covered; assessing young infants at home and arranging timely transport of sick young infants to study hospitals for physician confirmation of illness; and specimen collection and treatment. A large workforce is deployed in a 3-tier system in the field, while clinical, microbiology, laboratory and data management teams collaborate dynamically. Mobile phones with text message capability, integration with the Odisha State government's health system, involvement of local communities and strict monitoring at different levels have been critical in addressing these challenges.
This article describes the challenges and modalities adopted to collect complex and accurate data on etiology, timing of disease and associated factors for community-acquired neonatal infections. Attention to local culture and customs, training and employing community level workers and supervisors, involving existing government machinery, using technology (cell phones), and uninterrupted systematic monitoring are critical for implementing such complex protocols that aim to collect population-based data to drive policy.
南亚新生儿感染病因研究（ANISA）正在孟加拉国、印度和巴基斯坦的5个地点开展，以获取社区环境中病原体的深入信息。确定怀孕情况，登记出生信息，并对幼儿进行随访至59日龄，按照通用方案定期评估是否可能发生严重细菌感染。从疑似病例中采集样本。本文描述了实施通用ANISA方案所面临的挑战以及为适应印度奥里萨邦研究点所做的修改。
实施该方案的主要挑战包括需要覆盖地理面积大、人口超过35万；在家中评估幼儿并安排患病幼儿及时转运至研究医院以便医生确诊病情；以及样本采集和治疗。在实地部署了一支庞大的三级系统工作队伍，同时临床、微生物学、实验室和数据管理团队动态协作。具备短信功能的手机、与奥里萨邦政府卫生系统的整合、当地社区的参与以及不同层面的严格监测对于应对这些挑战至关重要。
本文描述了为收集关于社区获得性新生儿感染的病因、疾病发生时间及相关因素的复杂而准确的数据所面临的挑战及采用的方式。关注当地文化习俗、培训和雇佣社区层面工作人员及监督员、利用现有政府机构、使用技术（手机）以及持续的系统监测对于实施此类旨在收集基于人群的数据以推动政策制定的复杂方案至关重要。
