Department of Pediatrics, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of Statistics, University of Lucknow, Lucknow, Uttar Pradesh, India.
PLoS One. 2020 Jun 4;15(6):e0234212. doi: 10.1371/journal.pone.0234212. eCollection 2020.
Based on World Health Organization guidelines, Government of India recommended management of possible serious bacterial infection (PSBI) in young infants up to two months of age on an outpatient basis where referral is not feasible. We implemented the guideline in program setting to increase access to treatment with high treatment success and low resultant mortality.
Implementation research was conducted in four rural blocks of Lucknow district in Uttar Pradesh, India. It included policy dialogues with the central and state government and district level officials. A Technical Support Unit was established. Thereafter, capacity building across all cadres of health workers in the implementation area was done for strengthening of home based newborn care (HBNC) program, skills enhancement for identification and management of PSBI, logistics management to ensure availability of necessary supplies, monitoring and evaluation as well as providing feedback. Data was collected by the research team.
From June 2017 to February 2019 there were 24,448 live births in a population of 856106. We identified 1302 infants, aged 0-59 days, with any sign of PSBI leading to a coverage of 53% (1302/2445), assuming an incidence of 10%. However, in the establishment phase the coverage was 33%, while it was 85% in the implementation phase. Accredited social health activists (ASHAs) identified 81.2% (1058/1302) cases while rest were identified by families. ASHAs increased home visits within first 7 days of life in home based newborn care program from 74.3% (2781/3738) to 89.0% (3128/3513) and detection of cases of PSBI from 1.6% (45/2781) to 8.7% (275/3128) in the first and last quarter of the project, respectively. Of these 18.7% (244/1302) refused referral to government health system and 6.7% (88/1302) were treated in a hospital. Among cases of PSBI, there were 13.3% (173/1302) cases of fast breathing in young infant aged 7-59 days in whom referral was not needed. Of these 147 were treated by oral amoxicillin and 95.2% (140/147) were cured. Among those who needed referral, simplified treatment was given when referral was refused. There were 2.9% (37/1302) cases of fast breathing at ages of 0-6 days of which 34 were treated by simplified treatment with100% (34/34) cured;66.5% (866/1302) were cases of clinical severe infection of which 685 treated by simplified treatment with94.2% (645/685)cured and 09 died;17.3% (226/1302) cases of critical illness of which 93 were treated by simplified treatment, as a last resort, 72% (67/93) cured and 16 died. Among 255 cases who either did not seek formal treatment or sought it at private facilities, 96 died.
Simplified treatment for PSBI is feasible in public program settings in northern India with good cure rates. It required system strengthening and supportive supervision.
根据世界卫生组织的指南，印度政府建议在可行的情况下，对 2 个月以下的门诊患儿进行可能的严重细菌感染（PSBI）管理，不进行转诊。我们在项目中实施了该指南，以增加治疗的可及性，提高治疗成功率，降低死亡率。
在印度北方邦勒克瑙区的四个农村地区开展实施研究。它包括与中央和邦政府以及地区级官员进行政策对话。成立了一个技术支持单位。此后，对实施地区所有卫生工作者进行了能力建设，以加强家庭新生儿护理（HBNC）项目，提高识别和管理 PSBI 的技能，加强后勤管理以确保必要供应品的供应，进行监测和评估以及提供反馈。研究小组收集了数据。
从 2017 年 6 月至 2019 年 2 月，在 856106 人的人口中，有 24448 名活产儿。我们发现了 1302 名患有任何 PSBI 迹象的 0-59 天大的婴儿，覆盖率为 53%（1302/2445），假设发病率为 10%。然而，在建立阶段，覆盖率为 33%，而在实施阶段为 85%。认证的社会健康活动家（ASHA）识别了 81.2%（1058/1302）的病例，其余病例由家庭识别。ASHA 增加了家庭在新生儿家庭护理方案中的首次 7 天内的家访次数，从 74.3%（2781/3738）增加到 89.0%（3128/3513），在项目的第一和最后一个季度，检测到 PSBI 的病例分别从 1.6%（45/2781）增加到 8.7%（275/3128）。其中 18.7%（244/1302）拒绝转至政府卫生系统，6.7%（88/1302）在医院接受治疗。在 PSBI 病例中，有 13.3%（173/1302）例年龄在 7-59 天的婴儿呼吸急促，不需要转诊。其中 147 例接受口服阿莫西林治疗，95.2%（140/147）治愈。在那些需要转诊的病例中，当转诊被拒绝时，给予简化治疗。有 2.9%（37/1302）例 0-6 天龄婴儿呼吸急促，其中 34 例接受简化治疗，治愈率为 100%（34/34）；66.5%（866/1302）为临床严重感染病例，其中 685 例接受简化治疗，治愈率为 94.2%（645/685），09 例死亡；17.3%（226/1302）为危重病例，其中 93 例接受简化治疗，作为最后的手段，72%（67/93）治愈，16 例死亡。在 255 例未寻求正规治疗或在私人机构寻求治疗的病例中，96 例死亡。
在印度北部的公共项目中，对 PSBI 进行简化治疗是可行的，治愈率较高。它需要加强系统和支持性监督。
