Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: coverage and compliance with referral.
Health Policy Plan
; 25(2): 112-24, 2010 Mar.
Article
en En
| MEDLINE
| ID: mdl-19917652
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.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Índice de Severidad de la Enfermedad
/
Tamizaje Neonatal
/
Agentes Comunitarios de Salud
/
Servicios de Salud Comunitaria
/
Servicios de Salud Materna
Tipo de estudio:
Clinical_trials
/
Diagnostic_studies
/
Evaluation_studies
/
Guideline
/
Prognostic_studies
/
Screening_studies
Aspecto:
Implementation_research
Límite:
Adult
/
Female
/
Humans
/
Male
/
Newborn
País/Región como asunto:
Asia
Idioma:
En
Revista:
Health Policy Plan
Asunto de la revista:
PESQUISA EM SERVICOS DE SAUDE
/
SAUDE PUBLICA
Año:
2010
Tipo del documento:
Article
País de afiliación:
Estados Unidos