Author(s): Sudipto Roy 1,*, Rutuja Patil 1, Aditi Apte 1, Kavita Thibe 1, Arun Dhongade 1, Bhagawan Pawar 2, Yasir Bin Nisar 3, Samira Aboubaker 4, Shamim Ahmad Qazi 4, Rajiv Bahl 3, Archana Patil 5, Sanjay Juvekar 1, Ashish Bavdekar 1
Globally 2.5 million neonatal deaths were documented in 2018, with Southern Asia having a neonatal mortality rate of 25 per 1000 live births . Worldwide, neonatal sepsis, pneumonia and meningitis together result in up to 25% of all newborn deaths [2,3]. Highest incidence of neonatal sepsis (17,000/ 1,00,000 live births) was reported from India . The mean incidence of bacterial infection among neonates in South Asia is reported as 13.2% per 1000 livebirths and bacterial infections accounted for 92% of the known causes of death due to possible serious bacterial infections. .
World Health Organization (WHO) labels potential neonatal sepsis as possible serious bacterial infections (PSBI) in young infants (0-59 days) and recommends referral to a hospital for injectable antibiotics and supportive care. However, in resource-limited settings, especially tribal and geographically difficult terrains, such referrals are often not feasible [6-9], due to distance, cost or cultural reasons [10,11]. Feasibility of treating severe infections in young infants in low resource settings on outpatient basis were first demonstrated in South-east Asia [6-9]. Subsequently, several large community based, randomized trials in Africa and Asia demonstrated the effectiveness of simplified antibiotic regimens in out-patient settings among young infants up to two months of age with signs of PSBI where referral was not feasible [12-16]. WHO in 2015 synthesized available evidence to develop global guidance for management of PSBI in young infants when referral is not feasible . The Government of India also approved a policy for management of PSBI where referral is not possible with simplified antibiotic regimen by primary health care providers [18,19].
However, implementation of such guideline in the public health system requires a multi-pronged approach and involves dialogue with the policy makers and program managers, understanding barriers and facilitators for implementation and providing technical support for implementation. While implementation challenges were well documented in controlled conditions in the above mention Asian and African countries, we could not find barriers to implementation of PSBI management within the public health system in India. Thus, an implementation research was planned across four different sites in India within the public health system to facilitate policy adoption and implementation of the WHO PSBI guideline. Maharashtra state has a relatively well functioning public health system and a private sector compared to many other states in India . However, its tribal areas still have poor access to health care due to lack of proper roads, inadequate number of health facilities as well as low level of income and education among tribal population . We describe here the process of implementation and outcomes of simplified management of PSBI in young infants in a tribal population from Western Maharashtra, India.
The aims of the implementation strategy were:
To set up a demonstration site to deliver...