| Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: coverage and compliance with referral. | |
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MedLine Citation:
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PMID: 19917652 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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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Authors:
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Gary L Darmstadt; 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; |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S. Date: 2009-11-16 |
Journal Detail:
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Title: Health policy and planning Volume: 25 ISSN: 1460-2237 ISO Abbreviation: Health Policy Plan Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-02-16 Completed Date: 2010-05-14 Revised Date: 2013-05-31 |
Medline Journal Info:
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Nlm Unique ID: 8610614 Medline TA: Health Policy Plan Country: England |
Other Details:
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Languages: eng Pagination: 112-24 Citation Subset: H |
Affiliation:
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Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA. gdarmsta@jhsph.edu |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Bangladesh Community Health Services* Community Health Workers* Female Humans Infant, Newborn Male Maternal Health Services* Neonatal Screening* Program Evaluation Rural Health Services Severity of Illness Index* Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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D43 TW007587-04/TW/FIC NIH HHS; //Wellcome Trust |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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