Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2009 Apr;28(4):304-10.
doi: 10.1097/INF.0b013e31819069e8.

Effectiveness of home-based management of newborn infections by community health workers in rural Bangladesh

Abdullah H Baqui  1 , Shams E Arifeen, Emma K Williams, Saifuddin Ahmed, Ishtiaq Mannan, Syed M Rahman, Nazma Begum, Habibur R Seraji, Peter J Winch, Mathuram Santosham, Robert E Black, Gary L Darmstadt
Affiliations
Randomized Controlled Trial

Effectiveness of home-based management of newborn infections by community health workers in rural Bangladesh

Abdullah H Baqui et al. Pediatr Infect Dis J. 2009 Apr.

Abstract

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Guidelines for assessment of neonates and management of sick neonates by community health workers
Figure 2
Figure 2
Timing of identification of neonatal infections by community health workers
Figure 3
Figure 3
Treatment Received for Very Severe Infection by Six-Month Intervals
See this image and copyright information in PMC

References

    1. UNICEF. State of the World’s Children 2008. New York: UNICEF; 2008.
    1. Lawn JE, Cousens S, Zupan J. 4 million neonatal deaths: when? Where? Why? Lancet. 2005;365:891–900. - PubMed
    1. Bang AT, Paul VK, Reddy HM, et al. Why do neonates die in rural Gadchiroli, India? (Part I): primary causes of death assigned by neonatologist based on prospectively observed records. J Perinatol. 2005;25 (Suppl 1):S29–34. - PubMed
    1. Baqui A, Darmstadt GL, Williams E, et al. Rates, timing and causes of neonatal deaths in rural India: implications for neonatal health programs. Bull WHO. 2006;84:706–713. - PMC - PubMed
    1. Darmstadt GL, Bhutta ZA, Cousens S, et al. Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet. 2005;365:977–988. - PubMed

Publication types