Effectiveness of home-based management of newborn infections by community health workers in rural Bangladesh.
Effectiveness of home-based management of newborn infections by community health workers in rural Bangladesh.
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DOI：
10.1097/inf.0b013e31819069e8
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发表时间：
2009-04
期刊：
影响因子：
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通讯作者：
Darmstadt GL
中科院分区：
文献类型：
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作者：
Baqui AH;Arifeen SE;Williams EK;Ahmed S;Mannan I;Rahman SM;Begum N;Seraji HR;Winch PJ;Santosham M;Black RE;Darmstadt GL
在低资源环境中，感染约占新生儿死亡的一半。有限的证据支持社区卫生工作者（CHW）对新生儿感染进行家庭治疗。在一项随机分组对照试验的一个研究组中，CHW使用20体征临床算法评估了家中的新生儿，并将患病新生儿分类为患有非常严重的疾病或可能患有非常严重的疾病。在两年的时间里，在研究地区记录了10 585例活产。CHW评估了8474例（80%）出生后第一周内的新生儿，并将有严重疾病体征的新生儿转诊。如果转诊失败，但父母同意家庭治疗，CHW治疗新生儿非常严重的疾病或可能非常严重的疾病与多种迹象，使用注射抗生素。对于非常严重的疾病，转诊依从性为34%（162/478例），家庭治疗接受率为43%（204/478例）。CHW治疗的病死率为4.4%（9/204），合格医疗机构治疗的病死率为14.2%（23/162），未接受治疗或接受其他不合格医疗机构治疗的病死率为28.5%（32/112）。在控制了治疗组之间背景特征和疾病体征的差异后，接受CHW治疗的新生儿的风险比为0.22（95%可信区间0.07-0.71）的新生儿期死亡和由合格提供者治疗的风险比为0.61（95%置信区间为0.37-0.99），与未接受治疗或由未经培训的提供者治疗的新生儿相比。观察到惊厥新生儿的死亡风险比显著增加（人力资源6.54; 95% CI 3.98-10.76）、胸部内抽（HR 2.38，95% CI 1.29-4.39）、体温< 35.3 ℃（HR 3.47，95% CI 1.30-9.24）、意识丧失（HR 7.92，95% CI 3.13-20.04）。在孟加拉国资源匮乏的环境中，社区卫生工作者对新生儿非常严重的疾病进行家庭治疗是有效和可以接受的。
Infections account for about half of neonatal deaths in low-resource settings. Limited evidence supports home-based treatment of newborn infections by community health workers (CHW). In one study arm of a cluster randomized controlled trial, CHWs assessed neonates at home using a 20-sign clinical algorithm and classified sick neonates as having very severe disease or possible very severe disease. Over a two-year period, 10 585 live births were recorded in the study area. CHWs assessed 8474 (80%) of the neonates within the first week of life and referred neonates with signs of severe disease. If referral failed but parents consented to home treatment, CHWs treated neonates with very severe disease or possible very severe disease with multiple signs, using injectable antibiotics. For very severe disease, referral compliance was 34% (162/478 cases), and home treatment acceptance was 43% (204/478 cases). The case fatality rate was 4.4% (9/204) for CHW treatment, 14.2% (23/162) for treatment by qualified medical providers, and 28.5% (32/112) for those who received no treatment or who were treated by other unqualified providers. After controlling for differences in background characteristics and illness signs among treatment groups, newborns treated by CHWs had a hazard ratio of 0.22 (95% confidence interval 0.07–0.71) for death during the neonatal period and those treated by qualified providers had a hazard ratio of 0.61 (95% confidence interval of 0.37–0.99), compared with newborns who received no treatment or were treated by untrained providers. Significantly increased hazards ratios of death were observed for neonates with convulsions (HR 6.54; 95% CI 3.98–10.76), chest in-drawing (HR 2.38, 95% CI 1.29–4.39), temperature < 35.3°C (HR 3.47, 95% CI 1.30–9.24), unconsciousness (HR 7.92, 95% CI 3.13–20.04). Home treatment of very severe disease in neonates by CHWs was effective and acceptable in a low-resource setting in Bangladesh.