Provider performance and facility readiness for managing infections in young infants in primary care facilities in rural Bangladesh.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
01
11
2019
accepted:
18
02
2020
entrez:
23
4
2020
pubmed:
23
4
2020
medline:
2
7
2020
Statut:
epublish
Résumé
Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0-59 days) using simplified antibiotic regimens when compliance with hospital referral is not feasible. Bangladesh was one of the first countries to adopt WHO's guidelines for implementation. We report results of an implementation research study that assessed facility readiness and provider performance in three rural sub-districts of Bangladesh during August 2015-August 2016. This study took place in 19 primary health centers. Facility readiness was assessed using checklists completed by study staff at three time points. To assess provider performance, we extracted data for all infection cases from facility registers and compared providers' diagnosis and treatment against the guidelines. We plotted classification and dosage errors across the study period and superimposed a locally weighted smoothed (LOWESS) curve to analyze changes in performance over time. Focus group discussions (N = 2) and in-depth interviews (N = 28) with providers were conducted to identify barriers and facilitators for facility readiness and provider performance. At baseline, none of the facilities had adequate supply of antibiotics. During the 10-month period, 606 sick infants with signs of infection presented at the study facilities. Classification errors were identified in 14.9% (N = 90/606) of records. For infants receiving the first dose(s) of antibiotic treatment (N = 551), dosage errors were identified in 22.9% (N = 126/551) of the records. Distribution of errors varied by facility (35.7% [IQR: 24.7-57.4%]) and infection severity. Errors were highest at the beginning of the study period and decreased over time. Qualitative data suggest errors in early implementation were due to changes in providers' assessment and treatment practices, including confusion about classifying an infant with multiple signs of infection, and some providers' concerns about the efficacy of simplified antibiotic regimens. Strategies to monitor early performance and targeted supports are important for enhancing implementation fidelity when introducing complex guidelines in new settings. Future research should examine providers' assessment of effectiveness of simplified treatment and address misconceptions about superiority of broader spectrum antibiotics for treating community-acquired neonatal infections in this context.
Sections du résumé
BACKGROUND
Neonatal infections remain a leading cause of newborn deaths globally. In 2015, WHO issued guidelines for managing possible serious bacterial infection (PSBI) in young infants (0-59 days) using simplified antibiotic regimens when compliance with hospital referral is not feasible. Bangladesh was one of the first countries to adopt WHO's guidelines for implementation. We report results of an implementation research study that assessed facility readiness and provider performance in three rural sub-districts of Bangladesh during August 2015-August 2016.
METHODS
This study took place in 19 primary health centers. Facility readiness was assessed using checklists completed by study staff at three time points. To assess provider performance, we extracted data for all infection cases from facility registers and compared providers' diagnosis and treatment against the guidelines. We plotted classification and dosage errors across the study period and superimposed a locally weighted smoothed (LOWESS) curve to analyze changes in performance over time. Focus group discussions (N = 2) and in-depth interviews (N = 28) with providers were conducted to identify barriers and facilitators for facility readiness and provider performance.
RESULTS
At baseline, none of the facilities had adequate supply of antibiotics. During the 10-month period, 606 sick infants with signs of infection presented at the study facilities. Classification errors were identified in 14.9% (N = 90/606) of records. For infants receiving the first dose(s) of antibiotic treatment (N = 551), dosage errors were identified in 22.9% (N = 126/551) of the records. Distribution of errors varied by facility (35.7% [IQR: 24.7-57.4%]) and infection severity. Errors were highest at the beginning of the study period and decreased over time. Qualitative data suggest errors in early implementation were due to changes in providers' assessment and treatment practices, including confusion about classifying an infant with multiple signs of infection, and some providers' concerns about the efficacy of simplified antibiotic regimens.
CONCLUSIONS
Strategies to monitor early performance and targeted supports are important for enhancing implementation fidelity when introducing complex guidelines in new settings. Future research should examine providers' assessment of effectiveness of simplified treatment and address misconceptions about superiority of broader spectrum antibiotics for treating community-acquired neonatal infections in this context.
Identifiants
pubmed: 32320993
doi: 10.1371/journal.pone.0229988
pii: PONE-D-19-30502
pmc: PMC7176463
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0229988Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
PLoS One. 2009 Jun 17;4(6):e5937
pubmed: 19536288
Bangladesh Med Res Counc Bull. 2009 Aug;35(2):53-6
pubmed: 20120780
Am J Trop Med Hyg. 2012 Nov;87(5 Suppl):127-136
pubmed: 23136288
Lancet. 2015 May 2;385(9979):1767-1776
pubmed: 25842221
Arch Dis Child. 2011 Nov;96(11):1052-9
pubmed: 21220263
J Trop Pediatr. 2011 Feb;57(1):3-8
pubmed: 21278059
Bull World Health Organ. 2005 Apr;83(4):260-7
pubmed: 15868016
Lancet Glob Health. 2018 Nov;6(11):e1163-e1175
pubmed: 30309799
BMJ Glob Health. 2019 Mar 7;4(2):e001257
pubmed: 30997169
BMJ Glob Health. 2018 Sep 10;3(5):e000837
pubmed: 30233833
PLoS One. 2019 May 31;14(5):e0217617
pubmed: 31150458
Hum Resour Health. 2011 Jan 22;9:3
pubmed: 21255446
Lancet. 2018 Nov 17;392(10160):2214-2228
pubmed: 30314860
Lancet Infect Dis. 2013 Dec;13(12):1057-98
pubmed: 24252483
Int J Infect Dis. 2019 Mar;80:54-61
pubmed: 30634043
Lancet. 2013 Nov 23;382(9906):1746-55
pubmed: 24268003
BMC Med Ethics. 2015 Dec 01;16(1):80
pubmed: 26625723
BMC Pregnancy Childbirth. 2015;15 Suppl 2:S6
pubmed: 26391217
J Health Popul Nutr. 2019 Dec 6;38(1):41
pubmed: 31810496
Ann Clin Microbiol Antimicrob. 2014 Apr 22;13:15
pubmed: 24755269
BMJ. 2019 Jan 22;364:k5314
pubmed: 30670451
Proc Natl Acad Sci U S A. 2018 Apr 10;115(15):E3463-E3470
pubmed: 29581252
J Perinatol. 2016 Jan;36(1):71-6
pubmed: 26540248
PLoS One. 2019 Apr 17;14(4):e0214922
pubmed: 30995274
Lancet. 2008 Sep 6;372(9641):822-30
pubmed: 18715634
Lancet. 2008 Jan 12;371(9607):135-42
pubmed: 18191685
Lancet. 2015 Jan 31;385(9966):430-40
pubmed: 25280870
Cochrane Database Syst Rev. 2016 Jun 22;(6):CD010123
pubmed: 27378094
Lancet. 2008 Jun 7;371(9628):1936-44
pubmed: 18539225
Arch Dis Child. 2015 May;100(5):454-9
pubmed: 25503715
Implement Sci. 2009 Aug 07;4:50
pubmed: 19664226
Lancet. 2017 Dec 17;388(10063):3027-3035
pubmed: 27839855
PLoS One. 2017 Jan 23;12(1):e0170267
pubmed: 28114415
Lancet Glob Health. 2017 Feb;5(2):e177-e185
pubmed: 27988146
Pediatr Infect Dis J. 2013 Sep;32 Suppl 1:S3-6
pubmed: 23945573
Lancet. 2009 Aug 1;374(9687):393-403
pubmed: 19647607
Am J Trop Med Hyg. 2013 Jul;89(1 Suppl):62-68
pubmed: 23629937
Lancet. 2018 Jul 14;392(10142):145-159
pubmed: 30025808
BMJ. 2017 Mar 6;356:i6795
pubmed: 28264797
Lancet Infect Dis. 2019 Jan;19(1):67-75
pubmed: 30522834
PLoS Med. 2010 Mar 09;7(3):e1000213
pubmed: 20231868
Lancet Glob Health. 2015 May;3(5):e279-87
pubmed: 25841891
Adm Policy Ment Health. 2011 Mar;38(2):65-76
pubmed: 20957426
Infect Dis Clin North Am. 2009 Dec;23(4):791-815, vii
pubmed: 19909885
Health Serv Res. 2007 Aug;42(4):1758-72
pubmed: 17286625
J Health Popul Nutr. 2012 Mar;30(1):99-108
pubmed: 22524126
Pediatr Infect Dis J. 2013 Sep;32 Suppl 1:S46-9
pubmed: 23945576
Virulence. 2014 Jan 1;5(1):170-8
pubmed: 24185532
BMC Pediatr. 2012 Dec 26;12:197
pubmed: 23268650