Ngadaya Esther, Manu Alexander, Mmweteni Mary, Burengelo Dorica, Philbert Doreen, Kagaruki Gibson, Isangula Kahabi, Senkoro Mbazi, Kimaro Godfather, Kahwa Amos, Mazige Fikiri, Bundala Felix, Iriya Nemes, Donard Francis, Kitinya Caritas, Minja Victor, Nyakairo Festo, Gupta Gagan, Pearson Luwei, Kim Minjoon, Mfinanga Sayoki, Baker Ulrika, Hailegebriel Tedbabe Degefie
National Institute for Medical Research-Muhimbili Centre, Dar es Salaam, Tanzania.
University of Ghana School of Public Health, Accra, Ghana.
PLoS One. 2024 Dec 5;19(12):e0310259. doi: 10.1371/journal.pone.0310259. eCollection 2024.
Severe bacterial infections (SBIs) are a leading cause of neonatal deaths in low- and middle-income countries. World Health Organization's (WHO's) guideline for outpatient management of danger signs indicating possible serious bacterial infections (PSBI) when referral is not possible was adopted by three pilot district councils in Mbeya Region, in Tanzania (Busekelo, Kyela and Mbarali Districts) in 2018 (the PSBI project). This study documented changes in practice during the PSBI project, and lessons learned. A cross-sectional study was conducted using both qualitative and quantitative data collection methods between July 2021 and January 2022, post-implementation. The study participants comprised stakeholders, health workers, community health workers, and mothers/fathers/caregivers who had a young infant with PSBI. Study tools included record review, quantitative, in-depth, and key informant interviews. Quantitative data were analysed using STATA version 15 (STATACorp Inc., TX, USA), whereas qualitative data were analysed using a framework analysis approach. Our assessment showed that 2,228 young infants (0-59 days old) from the three districts were classified as having PSBI. The majority, 1,607 (72.1%) had fast breathing as the only danger sign, while 621 (27.9%) were classified as having severe illness. All 621 young infants with severe illness were counselled and offered referral to a higher-level health facility; however, only 174 of them (28%) accepted the referral. The remaining 447 severely ill infants, for whom referral was not possible, were treated at the primary health facilities with gentamicin injection and amoxicillin dispersible tablets (DT). When referral is not feasible, outpatient treatment for young infants with signs of PSBI is possible within existing health system in Tanzania, based on experience after this pilot project. However, successful scale-up of outpatient management for PSBI will require commitments from government and key stakeholders to strengthen healthcare systems.
在低收入和中等收入国家，严重细菌感染（SBIs）是新生儿死亡的主要原因。2018年，坦桑尼亚姆贝亚地区的三个试点区议会（布塞凯洛、基埃拉和姆巴拉利区）采用了世界卫生组织（WHO）关于在无法转诊时对表明可能存在严重细菌感染（PSBI）的危险体征进行门诊管理的指南（PSBI项目）。本研究记录了PSBI项目实施期间的实践变化及经验教训。在项目实施后的2021年7月至2022年1月期间，采用定性和定量数据收集方法进行了一项横断面研究。研究参与者包括利益相关者、卫生工作者、社区卫生工作者以及家中有患有PSBI的幼儿的母亲/父亲/照顾者。研究工具包括记录审查、定量、深入和关键信息访谈。定量数据使用STATA 15版本（美国德克萨斯州STATACorp公司）进行分析，而定性数据则采用框架分析方法进行分析。我们的评估显示，来自这三个区的2228名幼儿（0至59日龄）被归类为患有PSBI。其中大多数，即1607名（72.1%）仅有呼吸急促这一危险体征，而621名（27.9%）被归类为患有严重疾病。所有621名患有严重疾病的幼儿都接受了咨询，并被建议转诊至更高层级的医疗机构；然而，其中只有174名（28%）接受了转诊。其余447名无法转诊的重症幼儿在初级卫生机构接受了庆大霉素注射和阿莫西林分散片（DT）治疗。根据该试点项目后的经验，在坦桑尼亚现有的卫生系统内，当无法转诊时，对有PSBI体征的幼儿进行门诊治疗是可行的。然而，要成功扩大PSBI门诊管理的规模，政府和关键利益相关者需要承诺加强医疗保健系统。
