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Randomized Controlled Trial
. 2010 Mar;25(2):112-24.
doi: 10.1093/heapol/czp048. Epub 2009 Nov 16.

Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: coverage and compliance with referral

Gary L Darmstadt  1 , Shams El Arifeen, Yoonjoung Choi, Sanwarul Bari, Syed M Rahman, Ishtiaq Mannan, Peter J Winch, A S M Nawshad Uddin Ahmed, Habibur Rahman Seraji, Nazma Begum, Robert E Black, Mathuram Santosham, Abdullah H Baqui; Bangladesh Projahnmo-2 (Mirzapur) Study Group
Affiliations
Randomized Controlled Trial

Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: coverage and compliance with referral

Gary L Darmstadt et al. Health Policy Plan. 2010 Mar.

Abstract

Background: Effective and scalable community-based strategies are needed for identification and management of serious neonatal illness.

Methods: As part of a community-based, cluster-randomized controlled trial of the impact of a package of maternal-neonatal health care, community health workers (CHWs) were trained to conduct household surveillance and to identify and refer sick newborns according to a clinical algorithm. Assessments of newborns by CHWs at home were linked to hospital-based assessments by physicians, and factors impacting referral, referral compliance and outcome were evaluated.

Results: Seventy-three per cent (7310/10,006) of live-born neonates enrolled in the study were assessed by CHWs at least once; 54% were assessed within 2 days of birth, but only 15% were attended at delivery. Among assessments for which referral was recommended, compliance was verified in 54% (495/919). Referrals recommended to young neonates 0-6 days old were 30% less likely to be complied with compared to older neonates. Compliance was positively associated with having very severe disease and selected clinical signs, including respiratory rate > or = 70/minute; weak, abnormal or absent cry; lethargic or less than normal movement; and feeding problem. Among 239 neonates who died, only 38% were assessed by a CHW before death.

Conclusions: Despite rigorous programmatic effort, reaching neonates within the first 2 days after birth remained a challenge, and parental compliance with referral recommendation was limited, particularly among young neonates. To optimize potential impact, community postnatal surveillance must be coupled with skilled attendance at delivery, and/or a worker skilled in recognition of neonatal illness must be placed in close proximity to the community to allow for rapid case management to avert early deaths.

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Figures

Figure 1
Figure 1
Surveillance profile for live births born in the intervention arm, February 2004–November 2006. *Hospital visit by the end of next day following the assessment. **Self-referral. ***Compliance. Referral recommendation is missing in 5 assessments, of which 2 were linked with hospital visit records by the end of next day of the assessment.
Figure 2
Figure 2
Distribution of age at death (day) by community health worker assessment status (n = 239).
See this image and copyright information in PMC

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