Figures & Tables
Figures
- FIGURE 1
Relationship Between Health Extension Workers, Volunteers, and Households in Identifying and Managing Newborn Infections, Rural Ethiopia
Abbreviations: HEW, Health Extension Worker; IMNCI, integrated management of neonatal and childhood illnesses; PSBI, possible severe bacterial infection; V, Volunteer.
- FIGURE 2
Algorithm for Assessment, Classification, and Treatment of Newborn Infection by Health Extension Workers at Intervention Health Posts
Abbreviation: PSBI, possible severe bacterial infection.
- FIGURE 3
Number of Newborns With at Least 1 Sign of PSBI Presenting at Health Centers or Health Posts by Study Arm, Rural Ethiopia, July 2011–June 2013
Abbreviation: PSBI, possible severe bacterial infection.
- FIGURE 4
Study Allocation and Participants Interviewed and Included in Main Outcome Analysis Using Endline Survey
Abbreviation: HH, household.
Tables
- TABLE 1. Description of Newborn Infection Management Intervention by Arm and Health System Level, Rural Ethiopia, 2008–2013
Control Intervention Community and Household Half-day meetings to orient religious and administrative leaders and other community representatives on the study purpose and to obtain community consent to conduct study in these areas Yes Yes 1-day meetings with religious and administrative leaders and other community representatives to select female volunteers for the study Yes Yes 4-day training for HEWs and volunteers on conducting home visits to counsel women and families on the importance of antenatal care, facility delivery, and postnatal care; birth preparedness (saving money, planning place of delivery, transport, and blood donor); healthy newborn care practices; recognition of danger signs in mothers and newborns that require prompt care seeking; postpartum family planning; and identification and referral of sick newborns Yes Yes 2-day refresher training for volunteers to reinforce initial 4-day training Yes Yes 3-day training for HEWs on how to work with and support volunteers Yes Yes Identification of pregnant women by study volunteers Yes Yes Pregnancy and postnatal home visits by HEWs and volunteers per training Yes Yes 1-day meetings to raise community awareness of the availability of treatment for sick newborns at health posts No Yes Health Post 6-day training for HEWs on assessment and referral of newborns with signs of PSBI and case management for sick children older than 2 months (using national iCCM materials) Yes Yes 1-day training for HEWs on treatment of newborns with signs of PSBI when referral is not possible or acceptable No Yes Monthly meetings among PO, HEWs, and volunteers to reinforce counseling skills, referral of sick newborns, and reporting on home visits Yes Yes Supervision of HEWs by POs Yes Yes Provision of antibiotics and supplies for PSBI case management to health posts No Yes Treatment of newborns with signs of PSBI by HEWs, if referral to the health center was not possible or acceptable No Yes Monthly PSBI case management review meetings between POs and HEWs No Yes Documentation of symptoms, diagnosis, treatment initiation, and referrals for sick young infants by HEWs on iCCM registers Yes Yes Tracking of the number and timing of antibiotic doses and outcome by HEWs No Yes Health Center 7-day training for health center staff on IMNCI using national curriculum Yes Yes Provision of antibiotics and supplies for PSBI case management to health centers Yes Yes Documentation of symptoms, diagnosis, treatment initiation, and referrals for sick young infants by health center staff on IMNCI registers Yes Yes Abbreviations: HEW, health extension worker; iCCM, integrated community case management; IMNCI, integrated management of neonatal and childhood illnesses; PSBI, possible severe bacterial infection; PO, project officer.
Comparison Intervention No. of households interviewed 58,944 60,408 No. of residents per household, median 5 5 No. of women of reproductive age interviewed 58,497 56,733 General fertility rate (no. of live births per 1,000 women of reproductive age) 163 169 No. of women with a live birth in past 1 year 9,531 9,600 Age in years of women with live birth in past 1 year, mean (SD) (range) 28 (6) (14–50) 28 (6) (14–50) No. of lifetime live births prior to interview among women with live birth in past 1 year, median 4 4 Neonatal mortality rate among women with live birth in past 1 year (deaths during days 0–27 per 1,000 live births) 33.6 35.0 No. of women with a live birth in past 60 days 1,371 1,358 Percentage of women with live birth in past 60 days who ever attended school 33% 26% No. of years of education among women with live birth in past 60 days who ever attended school 4 4 Wealth quintiles among women with live birth in past 60 days, No. (%) Lowest 287 (21%) 253 (19%) 2nd 258 (19%) 280 (21%) 3rd 274 (20%) 273 (20%) 4th 261 (19%) 280 (21%) Highest 280 (20%) 262 (19%) Missing 11 (1%) 10 (1%) Abbreviation: SD, standard deviation.
- TABLE 3. Comparison of Assessments of Newborn Danger Signs by HEWs and POs, Rural Ethiopia, 2011–2012
Danger Signs Identified by Both the HEW and PO Identified by HEW Only Identified by PO Only Agree Sign Not Present Convulsions 2 0 0 825 Not feeding well 4 1 0 811 Chest in-drawing 14 4 0 840 Grunting 8 5 1 832 Lack of movement 42 2 0 810 Fever 10 0 2 797 Low temperature 13 1 2 769 Abbreviations: HEW, Health Extension Worker; PO, Project Officer.
- TABLE 4. Neonatal Deaths at Baseline (2008–2009) and Endline (2013) by Study Arm and Timing of Deaths, Rural Ethiopia
Timing of Neonatal Deaths Comparison Intervention Intervention vs. Comparison Denominator N Mortality Rate (n) Denominator N Mortality Rate (n) Adjusted Risk Ratioa (95% CI) P Value Days 0–27 Baseline 9,531 live births 33.6 (320) 9,600 live births 35.0 (336) 0.94 (0.72, 1.22) .61 Endline 9,003 live births 22.7 (204) 9,744 live births 24.2 (236) Days 0–1 Baseline 9,531 live births 19.4 (185) 9,600 live births 17.4 (167) 1.04 (0.70, 1.55) .83 Endline 9,003 live births 11.6 (104) 9,744 live births 15.0 (146) Days 2–27 Baseline 9,346 surviving day 1 14.4 (135) 9,433 surviving day 1 17.9 (169) 0.83 (0.55, 1.24) .33 Endline 8,899 surviving day 1 11.2 (100) 9,598 surviving day 1 9.4 (90) Abbreviation: CI, confidence interval.
↵a Endline intervention vs. comparison, adjusted for baseline mortality risk and region.
In this issue
Effect on Neonatal Mortality of Newborn Infection Management at Health Posts When Referral Is Not Possible: A Cluster-Randomized Trial in Rural Ethiopia
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