Diagnosis and Antibiotic Therapy of Neonatal Infections by Health Care Workers

Abhay Bang, the Director of The Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli India, opened his presentation by describing the importance of neonatal sepsis as a cause of death. In a preliminary survey carried out in Gadchiroli it was determined that 52 per cent of neonatal deaths were due to infections (Figure 3.1). Most of these deaths occurred in homes in villages where no treatment had been given.

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In order to reduce the number of neonatal deaths in Gadchiroli a program to use village health workers (VHW) to diagnose infections and treat with antibiotics was implemented. The program consisted of training the workers and carefully evaluating implementation and results.

This field trial was initially carried out in Gadchiroli (1996-2003) followed by seven sites in the provinceof Maharashtra (2003-2005) (Figures 3.2 and 3.3).

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Some of the villages were small and remote (Figure 3.4) with relatively primitive methods of farming and transportation (Figures 3.5 and 3.6).

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The initial part of the trial was a base line study in both intervention and control villages (Figure 3.7). “Intervention” was carried out in several steps. The first step was training VHW to observe and diagnose infections and record all details of these observations (Figure 3.8). The goal was to visit all newborn infants, to examine them and weigh them (Figure 3.9). The coverage was very good (Figure 3.10).

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 VHW used specific criteria to diagnose sepsis (Figure 3.11) and when evaluated they appeared to use these criteria effectively.

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VHW were trained to administer gentamycin by IM injection and to administer co-trimoxazole by mouth. The doses used were:

Gentamycin – 10 mg/day for 10 days for pre-term (<2500g) babies; 15 mg/day for 7 days for full term babies

Co-trimixasole (sulphamethoxazole 200mg + trimethoprim 40mg per 5ml) - 1.25 ml twice a day for 7 days

VHW were trained to prepare the injection (Figure 3.12) and administer it into the thigh (Figure 3.13).

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Parental acceptance of home therapy was very high (Figure 3.14). The results of treatment showed a highly significant drop in case fatality (CF) in the treatment group compared to the baseline period in which no antibiotic therapy was given (Figure 3.15). 

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