Identification and management of young infants with possible serious bacterial infection where referral was not feasible in rural Lucknow district of Uttar Pradesh, India: An implementation research

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From: PLoS ONE(Vol. 15, Issue 6)
Publisher: Public Library of Science
Document Type: Report
Length: 7,742 words
Lexile Measure: 1470L

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Author(s): Shally Awasthi 1,*, Naveen Kesarwani 1, Raj Kumar Verma 1, Girdhar Gopal Agarwal 2, Luxmi Shanker Tewari 1, Ravi Krishna Mishra 1, Lalji Shukla 1, Arun Kumar Raut 1, Shamim Ahmad Qazi 3, Samira Aboubaker 3, Yasir Bin Nisar 4, Rajiv Bahl 4, Monika Agarwal 5


India has been struggling tenaciously to tackle morbidity and mortality in children. In India, the Infant mortality rate per 1000 live births is 33 as compared to 41 in Uttar Pradesh, the most populous state. Neonatal mortality rate per 1000 live birth in India is 23 as compared to 30 in the state of Uttar Pradesh [1]. Leading infectious causes of mortality among young infants are pneumonia, sepsis and meningitis [2,3]. With an estimated 9.8% percent case fatality risk of possible serious bacterial infection (PSBI) [4] in low resource setting, survivors are also at risk of long term disability [5]. Therefore, early diagnosis and treatment is crucial for saving lives of young infants.

Early identification of illness by caregivers in sick young infants is difficult due to non-specific signs. World Health organization (WHO) recommends postnatal home visits by healthcare providers to facilitate early identification of danger signs and promote care seeking [6]. Government of India launched the Home Based Newborn Care (HBNC) program in 2011 for accelerated reduction of neonatal mortality, especially in rural and remote areas where access to health care is challenging [7]. In the HBNC program, an Accredited Social Health Activist (ASHA) visits mothers and neonates at home at least six times within the first 42 days of birth and refer sick infants to the public health facility. WHO recommends sick young infants with PSBI be referred to a hospital for inpatient treatment with a seven to ten-day course of injection ampicillin or benzyl penicillin plus gentamicin [8,9]. But hospitalization and life-saving treatment may not be accessible, acceptable or affordable to families in settings with high new-born mortality [10,11,12,13].

In 2014, Ministry of Health and Family Welfare, Government of India issued guideline for Auxiliary Nurse and Midwife (ANMs)for management of sepsis in young infants where referral is not feasible i.e., use of injection gentamicin plus oral amoxicillin as a pre-referral dose or completion of treatment for 7 days [14].WHO, in 2015, published the guideline for management of PSBI in young infants when referral is not feasible [15] based on evidence from several countries [13,16,17,18,19], which recommended a simplified treatment regimen with oral amoxicillin plus injection gentamicin for treatment of clinical severe infection and severe pneumonia. In 2017, government of India issued an addendum with a revised list of signs for classifying young infants as PSBI, consistent with the WHO guideline, removing nasal flaring, grunting, 10 or more skin pustules and blood in stool and recommended treatment of fast breathing young infants 7-59 day of age with oral amoxicillin only [20].

In each village, HBNC program is being implemented with ASHA as its grass root functionary. In this program, an ASHA does home visits on specific days (Days 1, 3,...

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Gale Document Number: GALE|A625751134