5450A1

[5450A.1] Community-Based Management of Neonatal InfectionsNepal

Penny Dawson, Sudhir Khanal, Robin Houston, Neena Khadka, Vijay Singh GC. Morang Innovative Neonatal Intervention, JSI R&T Inst. Inc., Kathmandu, Nepal; SAVE/US, Kathmandu, Nepal.

BACKGROUND: Neonatal deaths (NMR 39/1000 LBs)account for 60% of infant mortality in Nepal. WHO estimates that infections cause approximately 32% of neonatal deaths.
The MINI (Morang Innovative Neonatal Intervention) Program, implemented in one district by the Ministry of Health and Population (MOHP), with technical support from JSI RT Inst. Inc. and funding from The Bill and Melinda Gates Foundation through SAVE/SNL, is bringing identification and management of neonatal infections to the household and community level.

OBJECTIVE: To determine whether existing community-based health workers of the MOHP can perform a set of activities that result in improvement in the early identification and correct management of neonatal infections.

DESIGN/METHODS: Existing MOHP health workers were trained to enhance their ability to manage neonatal infections. Female Community Health Volunteers (FCHVs) were trained to: provide health education to new mothers about preventive measures and danger signs of infection; weigh all newborns; use a simple clinical algorithm to assess sick newborns; manage local bacterial infections (ophthalmic, umbilical, skin); initiate treatment for Possible Severe Bacterial Infections (PSBI) with cotrimoxazole; facilitate treatment with injectable gentamicin by Village Health Workers (VHWs); follow up and record outcomes; and record births and deaths.

RESULTS: To date, 14% of the1301 births recorded by the FCHVs were low birth weight (below 2500 grams). 16% presented with at least one danger sign for Possible Severe Bacterial Infection and 82% were first managed by the FCHVs. Most common danger signs were: fever (54%); skin pustules (34%); fast breathing (23%) and unable to suckle/feed (14%). 43% of the infants had two or more than 2 danger signs present. 89% completed a full 7-day course of treatment with gentamicin injections. There were 2 deaths among the treatment group. Death audits are being conducted to determine the most likely cause of death.

CONCLUSIONS: FCHVs are capable of assessing neonates, managing initial care and facilitating referral for gentamicin injections. Parents find this acceptable and awareness is growing in the community about the danger signs of neonatal infection and the need for immediate assessment and treatment.
The MINI program is well positioned to be incorporated into the MOHPs successful CB-IMCI program.

E-PAS2006:59:5450A.1

Tuesday, May 2, 2006 10:15 AM

Platform Session: Neonatal Infectious Diseases in Developing Countries (10:15 AM - 12:15 PM)

Course Number: 5450A