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© 2022 World Health OrganizationLicense: http://creativecommons.org/licenses/by/3.0/igo/ (the “License”) e Public Library of Science. This is an open access article distributed under the Creative Commons Attribution IGO License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Creative Commons Attribution License. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.

Abstract

Introduction

Research on simplified antibiotic regimens for outpatient treatment of ‘Possible Serious Bacterial Infection’ (PSBI) and the subsequent World Health Organization (WHO) guidelines provide an opportunity to increase treatment coverage. This multi-country implementation research initiative aimed to learn how to implement the WHO guideline in diverse contexts. These experiences have been individually published; this overview paper provides a summary of results and lessons learned across sites.

Methods summary

A common mixed qualitative and quantitative methods protocol for implementation research was used in eleven sites in the Democratic Republic of Congo (Equateur province), Ethiopia (Tigray and Oromia regions), India (Haryana, Himachal Pradesh, Maharashtra, and Uttar Pradesh states), Malawi (Central Region), Nigeria (Kaduna and Oyo states), and Pakistan (Sindh province). Key steps in implementation research were: i) policy dialogue with the national government and key stakeholders, ii) the establishment of a ‘Technical Support Unit’ with the research team and district level managers, and iii) development of an implementation strategy and its refinement using an iterative process of implementation, programme learning and evaluation.

Results summary

All sites successfully developed and evaluated an implementation strategy to increase coverage of PSBI treatment. During the study period, a total of 6677 young infants from the study catchment area were identified and treated at health facilities in the study area as inpatients or outpatients among 88179 live births identified. The estimated coverage of PSBI treatment was 75.7% (95% CI 74.8% to 78.6%), assuming a 10% incidence of PSBI among all live births. The treatment coverage was variable, ranging from 53.3% in Lucknow, India to 97.3% in Ibadan, Nigeria. The coverage of inpatient treatment ranged from 1.9% in Zaria, Nigeria, to 33.9% in Tigray, Ethiopia. The outpatient treatment coverage ranged from 30.6% in Pune, India, to 93.6% in Zaria, Nigeria. Overall, the case fatality rate (CFR) was 14.6% (95% CI 11.5% to 18.2%) for 0-59-day old infants with critical illness, 1.9% (95% CI 1.5% to 2.4%) for 0-59-day old infants with clinical severe infection and 0.1% for fast breathing in 7–59 days old. Among infants treated as outpatients, CFR was 13.7% (95% CI 8.7% to 20.2%) for 0-59-day old infants with critical illness, 0.9% (95% CI 0.6% to 1.2%) for 0-59-day old infants with clinical severe infection, and 0.1% for infants 7–59 days old with fast breathing.

Conclusion

Important lessons on how to conduct each step of implementation research, and the challenges and facilitators for implementation of PSBI management guideline in routine health systems are summarised and discussed. These lessons will be used to introduce and scale-up implementation in relevant Low- and middle-income countries.

Details

Title
A multi-country implementation research initiative to jump-start scale-up of outpatient management of possible serious bacterial infections (PSBI) when a referral is not feasible: Summary findings and implications for programs
Author
Yasir Bin Nisar; Contributed equally to this work with: Yasir Bin Nisar; Aboubaker, Samira; Shams El Arifeen; Ariff, Shabina; Arora, Narendra; Awasthi, Shally; Adejumoke Idowu Ayede; Baqui, Abdullah H; Bavdekar, Ashish; Berhane, Melkamu; Chandola, Temsunaro Rongsen; Abadi Leul; Salim Sadruddin; Tshefu, Antoinette; Robinson Wammanda; Nigussie, Assaye; Pyne-Mercier, Lee; Pearson, Luwei; Brandes, Neal; Wall, Steve; Qazi, Shamim A; Bahl, Rajiv  VIAFID ORCID Logo  ; Rajiv Bahl Shams El Arifeen; Rajiv Bahl Shabina Ariff; Rajiv Bahl Narendra Arora; Rajiv Bahl Shally Awasthi; Rajiv Bahl Adejumoke Idowu Ayede; Rajiv Bahl Abdullah H. Baqui; Rajiv Bahl Ashish Bavdekar; Rajiv Bahl Melkamu Berhane; Rajiv Bahl Temsunaro Rongsen Chandola; Rajiv Bahl Abadi Leul; Rajiv Bahl Salim Sadruddin; Rajiv Bahl Antoinette Tshefu; Rajiv Bahl Robinson Wammanda; Rajiv Bahl Assaye Nigussie; Rajiv Bahl Lee Pyne-Mercier; Rajiv Bahl Luwei Pearson; Rajiv Bahl Neal Brandes; Rajiv Bahl Steve Wall; Rajiv Bahl Shamim A. Qazi; Rajiv Bahl Rajiv Bahl Contributed equally to this work with: Yasir Bin Nisar
First page
e0269524
Section
Research Article
Publication year
2022
Publication date
Jun 2022
Publisher
Public Library of Science
e-ISSN
19326203
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2686268624
Copyright
© 2022 World Health OrganizationLicense: http://creativecommons.org/licenses/by/3.0/igo/ (the “License”) e Public Library of Science. This is an open access article distributed under the Creative Commons Attribution IGO License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Creative Commons Attribution License. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.