Treatment of neonatal infections: a multi-country analysis of health system bottlenecks and potential solutions

BMC Pregnancy and Childbirth

Research

Shamim A Qazi¹  Gary L Darmstadt²  Aline Simen-Kapeu³  Kim E Dickson³  Mark Young³  Christabel Nyange⁴  Grace Liu⁵  Steve Wall⁶  Joy E Lawn⁷  Sarah G Moxon⁷  Anna C Seale⁸ 

[1] Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Avenue Appia 20, 1211, Geneva 27, Switzerland;Department of Pediatrics, Stanford University School of Medicine, 94305, Stanford, CA, USA;Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, 10017, New York, NY, USA;Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, 10017, New York, NY, USA;Ross University Medical School, 2300 SW 145th Avenue, 33027, Miramar, FL, USA;Save the Children Federation, Inc., 501 Kings Highway East, Suite 400, 06825, Fairfield, CT, USA;Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, 20036, Washington, DC, USA;Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, 20036, Washington, DC, USA;Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK;Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, WC1E 7HT, London, UK;University College London Department of Infectious Diseases Informatics, UCL Institute for Health Informatics, Farr Institute, 222 Euston Road, NW1 2DA, London, UK;

关键词: Neonatal infections;    sepsis;    antibiotics;    bottlenecks;    barriers;    solutions;    primary health care;    community-based health care;   

DOI  :  10.1186/1471-2393-15-S2-S6

来源: Springer

【 摘 要 】

BackgroundAround one-third of the world's 2.8 million neonatal deaths are caused by infections. Most of these deaths are preventable, but occur due to delays in care-seeking, and access to effective antibiotic treatment with supportive care. Understanding variation in health system bottlenecks to scale-up of case management of neonatal infections and identifying solutions is essential to reduce mortality, and also morbidity.MethodsA standardised bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the development of the Every Newborn Action Plan. Country workshops involved technical experts to complete a survey tool, to grade health system "bottlenecks" hindering scale up of maternal-newborn intervention packages. Quantitative and qualitative methods were used to analyse the data, combined with literature review, to present priority bottlenecks and synthesise actions to improve case management of newborn infections.ResultsFor neonatal infections, the health system building blocks most frequently graded as major or significant bottlenecks, irrespective of mortality context and geographical region, were health workforce (11 out of 12 countries), and community ownership and partnership (11 out of 12 countries). Lack of data to inform decision making, and limited funding to increase access to quality neonatal care were also major challenges.ConclusionsRapid recognition of possible serious bacterial infection and access to care is essential. Inpatient hospital care remains the first line of treatment for neonatal infections. In situations where referral is not possible, the use of simplified antibiotic regimens for outpatient management for non-critically ill young infants has recently been reported in large clinical trials; WHO is developing a guideline to treat this group of young infants. Improving quality of care through more investment in the health workforce at all levels of care is critical, in addition to ensuring development and dissemination of national guidelines. Improved information systems are needed to track coverage and adequately manage drug supply logistics for improved health outcomes. It is important to increase community ownership and partnership, for example through involvement of community groups.

【 授权许可】

CC BY   
© Simen-Kapeu et al. 2015