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. 2023 Mar 14;45(1):176-188.
doi: 10.1093/pubmed/fdab409.

Implementation research to increase treatment coverage of possible serious bacterial infections in young infants when a referral is not feasible: lessons learnt

Shabina Ariff  1 , Sajid Bashir Soofi  1   2 , Zamir Suhag  3 , Suhail Chanar  2 , Maria Bhura  2 , Zaib Dahar  3 , Imran Ahmed  2 , Ali Turab  2 , Atif Habib  2 , Yasir Bin Nisar  4 , Samira Aboubaker  4 , Steve Wall  5 , Abdul Wahab Soomro  3 , Shamim Ahmad Qazi  6 , Rajiv Bahl  4 , Zulfiqar A Bhutta  2
Affiliations

Implementation research to increase treatment coverage of possible serious bacterial infections in young infants when a referral is not feasible: lessons learnt

Shabina Ariff et al. J Public Health (Oxf). .

Abstract

Background: The objective was to achieve high coverage of possible serious bacterial infections (PSBI) treatment using the World Health Organization (WHO) guideline for managing it on an outpatient basis when referral to a hospital is not feasible.

Methods: We implemented this guideline in the programme settings at 10 Basic Health Units (BHU) in two rural districts of Sindh in Pakistan using implementation research. A Technical Support Unit supported the programme to operationalize guidelines, built capacity of health workers through training, monitored their clinical skills, mentored them and assured quality. The community-based health workers visited households to identify sick infants and referred them to the nearest BHU for further management. The research team collected data.

Results: Of 17 600 identified livebirths, 1860 young infants with any sign of PSBI sought care at BHUs and 1113 (59.8%) were brought by families. We achieved treatment coverage of 95%, assuming an estimated 10% incidence of PSBI in the first 2 months of life and that 10% of young infants came from outside the study catchment area. All 923 infants (49%; 923/1860) 7-59 days old with only fast breathing (pneumonia) treated with outpatient oral amoxicillin were cured. Hospital referral was refused by 83.4% (781/937) families who accepted outpatient treatment; 92.2% (720/781) were cured and 0.8% (6/781) died. Twelve (7.6%; 12/156) died among those treated in a hospital.

Conclusion: It is feasible to achieve high coverage by implementing WHO PSBI management guidelines in a programmatic setting when a referral is not feasible.

Keywords: basic health unit; implementation research; lady health worker; possible serious bacterial infection; sick young infants; simplified antibiotic regimens.

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Figures

Fig. 1
Fig. 1
Map of the study area.
Fig. 2
Fig. 2
Conceptual framework for implementation research.
See this image and copyright information in PMC

References

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