Is Home-Based Diagnosis and Treatment of Neonatal Sepsis Feasible and Effective? Seven Years of Intervention in the Gadchiroli Field Trial (1996 to 2003) (original) (raw)

Journal of Perinatology volume 25, pages S62–S71 (2005)Cite this article

Abstract

OBJECTIVES:

To further evaluate our earlier findings on the feasibility and effectiveness of home-based management of neonatal sepsis by analysing 7 years data (1996 to 2003) from the field trial in Gadchiroli, India.

STUDY DESIGN:

Neonates in 39 villages were monitored by trained village health workers (VHWs) from 1995 onwards. In 1996, we trained VHWs to diagnose sepsis by using a clinical algorithm and provide domiciliary treatment using intramuscular gentamicin and oral co-trimoxazole. Health records for all neonates were kept by the VHWs, checked by field supervisors, and computerized. Live births and neonatal deaths were recorded by an independent vital statistics collection system. We evaluated the feasibility and effectiveness of this approach.

RESULTS:

During September 1996 to March 2003, VHWs monitored 93% of all neonates in 39 villages (_N_=5268). As compared to 552 cases of sepsis diagnosed by computer algorithm, VHWs correctly diagnosed 492 cases (89%). Parents agreed to home-based treatment for the majority of infants (448, 91%), refused treatment in 31 (6.4%) cases, and hospitalized 13 infants (2.6%). VHWs treated 470 neonates with antibiotics, that is, 8.9% of all neonates in community. Of 552 cases diagnosed by computer, VHWs correctly treated 448 (81.2%) and gave unnecessary treatment to 22/470 (4.7%) of treated neonates. The case fatality (CF) was 6.9% in treated cases vs 22% in untreated or 16.6% in the pre-intervention period (p<0.001). Home-based treatment resulted in 67.2% reduction in %CF among preterm and a 72% reduction among LBW neonates.

CONCLUSIONS:

Home-based management of neonates with suspected sepsis is acceptable to most parents, safe, and effective in reducing sepsis case fatality by nearly 60%. With proper selection, training, and supervision of health workers, this method may be applicable in areas in developing countries where access to hospital care is limited.

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References

  1. Save the children. State of the World's Newborn. Save the Children, Washington DC; 2001.
  2. Stoll BJ . Neonatal infections: a global perspective in: Remington JS, Klein JO, editors. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia: WB Saunders Company (in press).
  3. Bang AT, Bang RA, Baitule SB, Deshmukh MD, Reddy HM . Burden of morbidities and the unmet need for health care in rural neonates — a prospective observational study in Gadchiroli, India. Indian Pediatr 2001;38:952–965.
    CAS PubMed Google Scholar
  4. Bang AT, Reddy HM, Baitule SB, Deshmukh MD, Bang RA . The incidence of neonatal morbidities in community: variation by season and by day of life and the scope for prevention through better home care. J Perinatol 2005;25:S18–28.
    Article Google Scholar
  5. Bang AT, Bang RA, Baitule SB, Reddy HM, Deshmukh MD . Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 1999;354:1955–1961.
    Article CAS Google Scholar
  6. Bang AT, Paul VK, Reddy HM, Baitule SB . Why do neonates die in rural homes? (Part I): Primary causes of death assigned by neonatologist based on prospectively observed records. J Perinatol 2005;25:S29–34.
    Article Google Scholar
  7. Bang AT, Bang RA, Reddy HM, Deshmukh MD . Methods and the baseline situation of the field trial of home-based neonatal care in Gadchiroli, India. J Perinatol 2005;25:S11–S17.
    Article Google Scholar
  8. Stoll BJ . The fetus and the neonatal infant, Part XI, Section II, Infections of the newborn infant In: Behrman RE, Kliegman RM, Jenson HB, editors. Nelson's Textbook of Pediatrics. 17th ed. Philadelphia: W.B. Saunders; 2003. p. 623–640.
    Google Scholar
  9. Remington JS, Klein JO . Infectious Diseases of the Fetus and Newborn Infant. Philadelphia: WB Saunders Company; 1990. p. 641–642.
    Google Scholar
  10. Bang RA, Bang AT, Baitule M, et al. High prevalence of gynaecological diseases in rural Indian women. Lancet 1989;i:85–88.
    Article Google Scholar
  11. Bang AT, Rani RA, Morankar VP, Sontakke PG, Solanki JM . Pneumonia in neonates: can it be managed in the community? Arch Dis Childhood 1993;68:550–556.
    Article CAS Google Scholar
  12. Consensus Statement of the National Workshop on Home-based Neonatal Care jointly organized by the IAP, NNF, UNICEF and SEARCH, Gadchiroli, India, 1999.
  13. Consensus Statement of the National Workshop on ‘How to Reduce the IMR to 30?’ Gadchiroli, India. 31st March to 1st April 2003.
  14. Bang AT, Bang RA, Reddy HM, et al. Simple clinical criteria to identify sepsis/pneumonia in neonates in the community for treatment or referral. Ped Inf Dis J (in press).
  15. Registrar General of India. Civil Registration System. Government of India, New Delhi, 2002.

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Authors and Affiliations

  1. SEARCH (Society for Education, Action and Research in Community Health), Gadchiroli, India
    Abhay T Bang MD, MPH, Rani A Bang MD, MPH, Sanjay B Baitule DHMS, Hanimi M Reddy PhD & Mahesh D Deshmukh MSc
  2. Professor of Pediatrics, Emory University, Atlanta, GA, USA
    Barbara J Stoll MD

Authors

  1. Abhay T Bang MD, MPH
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  2. Rani A Bang MD, MPH
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  3. Barbara J Stoll MD
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  4. Sanjay B Baitule DHMS
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  5. Hanimi M Reddy PhD
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  6. Mahesh D Deshmukh MSc
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Corresponding author

Correspondence toAbhay T Bang MD, MPH.

Additional information

Financial support was provided by the John D. and Catherine T. MacArthur Foundation, The Ford Foundation, Saving Newborn Lives, Save the Children, USA, and The Bill and Melinda Gates Foundation.

Appendix A:

Appendix A:

The neonatal sepsis monitoring form in Gadchiroli

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Bang, A., Bang, R., Stoll, B. et al. Is Home-Based Diagnosis and Treatment of Neonatal Sepsis Feasible and Effective? Seven Years of Intervention in the Gadchiroli Field Trial (1996 to 2003).J Perinatol 25 (Suppl 1), S62–S71 (2005). https://doi.org/10.1038/sj.jp.7211273

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