TY - JOUR T1 - Reducing Sepsis Deaths in Newborns Through Home Visitation and Active Case Detection: Is it Realistic? JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT SP - 177 LP - 179 DO - 10.9745/GHSP-D-17-00201 VL - 5 IS - 2 AU - Stephen Hodgins AU - Robert McPherson Y1 - 2017/06/27 UR - http://www.ghspjournal.org/content/5/2/177.abstract N2 - Severe bacterial infection remains one of the major causes of newborn deaths in low-income countries. A key challenge for reducing this burden is making definitive treatment more easily available. Active case detection through early postnatal home visits can work under trial conditions but is difficult to implement at scale under routine conditions. In many settings, making treatment available at peripheral-level primary health care facilities may be more feasible.See related article by Hailegebriel.Serious bacterial infection remains 1 of the 3 leading causes of newborn deaths globally1 and in some high-burden settings accounts for more than a third of such deaths. Reducing this burden requires strategies that result in more timely case identification and initiation of suitable antibiotic treatment. In many low-income, high-burden settings, achieving such improvements requires services to be pushed out more peripherally to make them more easily accessible. This is particularly challenging in places where much of the population does not currently have easy access to hospital-based care.Bang et al. (1999)2—working in a poorly served, comparatively remote area of India—piloted an approach to reduce newborn mortality that relied on community health workers (CHWs) to provide postnatal home visits, with an intensive, closely monitored, 7-visit schedule over the first month of life. These CHWs were to identify and treat cases of possible sepsis, using oral cotrimoxazole and intramuscular gentamicin. The package also included having the CHWs assist traditional birth attendants at childbirth, resuscitating any newborns not spontaneously initiating breathing at birth. This quasi-experimental study achieved greater than 60% reduction in newborn deaths. These findings challenged a fatalistic attitude then widespread in the global health community, which assumed that important progress in reducing newborn mortality would not be possible without wide access to sophisticated hospital-based services.Almost a decade later, in 2008 Baqui and … ER -