Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: coverage and compliance with referral.

Health Policy and Planning
Gary L DarmstadtBangladesh Projahnmo-2 (Mirzapur) Study Group

Abstract

Effective and scalable community-based strategies are needed for identification and management of serious neonatal illness. 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. 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 neo...Continue Reading

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Citations

Aug 13, 2009·The Journal of Infectious Diseases·Gary L DarmstadtUNKNOWN Bangladesh Projahnmo-2 (Mirzapur) Study Group
Jun 15, 2011·BMC Medical Ethics·Emily S GurleyStephen P Luby
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