Association of clinical signs of possible serious bacterial infections identified by community health workers with mortality of young infants in South Asia: a prospective, observational cohort studyResearch in context
Summary: Background: The World Health Organization (WHO) has developed guidance for community health workers (CHWs) in identifying sick young infants based on clinical signs. We conducted a prospective, observational cohort study to characterise mortality risk of young infants based on their clinic...
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2025-02-01
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| author | Gary L. Darmstadt Saifuddin Ahmed Mohammad Shahidul Islam Safa Abdalla Shams El Arifeen Melissa L. Arvay Abdullah H. Baqui Zulfiqar A. Bhutta Anuradha Bose Nicholas E. Connor Belal Hossain Rita Isaac Arif Mahmud Dipak K. Mitra Luke C. Mullany Imran Nisar Kalpana Panigrahi Pinaki Panigrahi Qazi Sadeq-ur Rahman Senjuti Saha Sajid B. Soofi Nardos Solomon Mathuram Santosham Stephanie J. Schrag Shamim A. Qazi Samir K. Saha |
| author_facet | Gary L. Darmstadt Saifuddin Ahmed Mohammad Shahidul Islam Safa Abdalla Shams El Arifeen Melissa L. Arvay Abdullah H. Baqui Zulfiqar A. Bhutta Anuradha Bose Nicholas E. Connor Belal Hossain Rita Isaac Arif Mahmud Dipak K. Mitra Luke C. Mullany Imran Nisar Kalpana Panigrahi Pinaki Panigrahi Qazi Sadeq-ur Rahman Senjuti Saha Sajid B. Soofi Nardos Solomon Mathuram Santosham Stephanie J. Schrag Shamim A. Qazi Samir K. Saha |
| author_sort | Gary L. Darmstadt |
| collection | DOAJ |
| description | Summary: Background: The World Health Organization (WHO) has developed guidance for community health workers (CHWs) in identifying sick young infants based on clinical signs. We conducted a prospective, observational cohort study to characterise mortality risk of young infants based on their clinical signs. Methods: We conducted a population-based, prospective observational cohort study at five sites in Bangladesh (Sylhet, November 01, 2011–December 31, 2013), India (Vellore and Odisha, September 01, 2013–February 28, 2015), and Pakistan (Karachi, January 01, 2012–December 31, 2013; Matiari, March 01, 2012–December 31, 2013) to identify newborn infants who were followed-up by CHWs through 10 scheduled home visits over the first 60 completed days after birth to identify signs of possible serious bacterial infection (PSBI). We determined the frequency of signs and conducted Cox regression to investigate the association of signs with mortality risk within 7 days of identification of the signs. Findings: CHWs made 522,309 visits to assess 63,017 young infants and found ≥1 sign(s) of PSBI at 14,245 visits (2.7%), including 5.8% (5568 of 96,390) and 1.8% (6635 of 365,769) of visits of infants 0–<3 and 7–<60 days of age, respectively. Each of the seven signs of PSBI when found alone was associated with significantly (p < 0.0001) increased risk for mortality, which increased further if any other additional sign of PSBI was found concurrently. Over the young infant period (days 0–<60) CHW identification of no movement or movement only on stimulation was associated with the highest risk for mortality [adjusted hazard ratio (aHR) 73.0, 95% confidence interval (CI) 44.4–119.9] followed by poor feeding (aHR 31.9, 95% CI 24.1–42.3) and hypothermia (<35.5 °C) (aHR 31.4, 95% CI 23.5–41.9). Hypothermia had particularly high risk for mortality during days 7–<60 (HR 45.1, 95% CI 27.6–73.4). Interpretation: WHO reconsideration of hypothermia as a sign of critical illness is warranted. Implementation research is urgently needed to reduce infant mortality by ensuring immediate referrals and interventions for children identified early by CHWs with no movement or movement only on stimulation, hypothermia, or poor feeding, especially in resource-poor settings. Funding: Bill and Melinda Gates Foundation, New Venture Fund for Global Policy and Advocacy. |
| format | Article |
| id | doaj-art-20b18331b0f14308adb9cfee2b930f66 |
| institution | Kabale University |
| issn | 2589-5370 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj-art-20b18331b0f14308adb9cfee2b930f662025-01-20T04:17:49ZengElsevierEClinicalMedicine2589-53702025-02-0180103070Association of clinical signs of possible serious bacterial infections identified by community health workers with mortality of young infants in South Asia: a prospective, observational cohort studyResearch in contextGary L. Darmstadt0Saifuddin Ahmed1Mohammad Shahidul Islam2Safa Abdalla3Shams El Arifeen4Melissa L. Arvay5Abdullah H. Baqui6Zulfiqar A. Bhutta7Anuradha Bose8Nicholas E. Connor9Belal Hossain10Rita Isaac11Arif Mahmud12Dipak K. Mitra13Luke C. Mullany14Imran Nisar15Kalpana Panigrahi16Pinaki Panigrahi17Qazi Sadeq-ur Rahman18Senjuti Saha19Sajid B. Soofi20Nardos Solomon21Mathuram Santosham22Stephanie J. Schrag23Shamim A. Qazi24Samir K. Saha25Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA; Corresponding author. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, 94305, USA.Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USAChild Health Research Foundation, Dhaka, BangladeshDepartment of Pediatrics, Stanford University School of Medicine, Stanford, CA, USAInternational Centre for Diarrhoeal Disease Research Bangladesh (icddrb), Dhaka, BangladeshCenters for Disease Control and Prevention, Atlanta, GA, USADepartment of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USACentre for Global Child Health, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute for Global Health and Development, The Aga Khan University, Karachi, PakistanChristian Medical College and Hospital Vellore, Vellore, IndiaDepartment of Clinical Research, London School of Hygiene & Tropical Medicine, London, UKDepartment of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USAChristian Medical College and Hospital Vellore, Vellore, IndiaDepartment of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USADepartment of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USADepartment of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USADepartment of Pediatrics and Child Health, The Aga Khan University, Karachi, PakistanAIPH University, Bhubaneswar, IndiaDepartment of Pediatrics, Georgetown University Medical Center, Washington, DC, USAInternational Centre for Diarrhoeal Disease Research Bangladesh (icddrb), Dhaka, BangladeshChild Health Research Foundation, Dhaka, BangladeshDepartment of Pediatrics and Child Health, The Aga Khan University, Karachi, PakistanDepartment of Pediatrics, Stanford University School of Medicine, Stanford, CA, USADepartment of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USACenters for Disease Control and Prevention, Atlanta, GA, USARetired, World Health Organization, Geneva, SwitzerlandChild Health Research Foundation, Dhaka, BangladeshSummary: Background: The World Health Organization (WHO) has developed guidance for community health workers (CHWs) in identifying sick young infants based on clinical signs. We conducted a prospective, observational cohort study to characterise mortality risk of young infants based on their clinical signs. Methods: We conducted a population-based, prospective observational cohort study at five sites in Bangladesh (Sylhet, November 01, 2011–December 31, 2013), India (Vellore and Odisha, September 01, 2013–February 28, 2015), and Pakistan (Karachi, January 01, 2012–December 31, 2013; Matiari, March 01, 2012–December 31, 2013) to identify newborn infants who were followed-up by CHWs through 10 scheduled home visits over the first 60 completed days after birth to identify signs of possible serious bacterial infection (PSBI). We determined the frequency of signs and conducted Cox regression to investigate the association of signs with mortality risk within 7 days of identification of the signs. Findings: CHWs made 522,309 visits to assess 63,017 young infants and found ≥1 sign(s) of PSBI at 14,245 visits (2.7%), including 5.8% (5568 of 96,390) and 1.8% (6635 of 365,769) of visits of infants 0–<3 and 7–<60 days of age, respectively. Each of the seven signs of PSBI when found alone was associated with significantly (p < 0.0001) increased risk for mortality, which increased further if any other additional sign of PSBI was found concurrently. Over the young infant period (days 0–<60) CHW identification of no movement or movement only on stimulation was associated with the highest risk for mortality [adjusted hazard ratio (aHR) 73.0, 95% confidence interval (CI) 44.4–119.9] followed by poor feeding (aHR 31.9, 95% CI 24.1–42.3) and hypothermia (<35.5 °C) (aHR 31.4, 95% CI 23.5–41.9). Hypothermia had particularly high risk for mortality during days 7–<60 (HR 45.1, 95% CI 27.6–73.4). Interpretation: WHO reconsideration of hypothermia as a sign of critical illness is warranted. Implementation research is urgently needed to reduce infant mortality by ensuring immediate referrals and interventions for children identified early by CHWs with no movement or movement only on stimulation, hypothermia, or poor feeding, especially in resource-poor settings. Funding: Bill and Melinda Gates Foundation, New Venture Fund for Global Policy and Advocacy.http://www.sciencedirect.com/science/article/pii/S2589537025000021NewbornMortalitySepsisPossible serious bacterial infectionCommunity health workersIntegrated management of childhood illness |
| spellingShingle | Gary L. Darmstadt Saifuddin Ahmed Mohammad Shahidul Islam Safa Abdalla Shams El Arifeen Melissa L. Arvay Abdullah H. Baqui Zulfiqar A. Bhutta Anuradha Bose Nicholas E. Connor Belal Hossain Rita Isaac Arif Mahmud Dipak K. Mitra Luke C. Mullany Imran Nisar Kalpana Panigrahi Pinaki Panigrahi Qazi Sadeq-ur Rahman Senjuti Saha Sajid B. Soofi Nardos Solomon Mathuram Santosham Stephanie J. Schrag Shamim A. Qazi Samir K. Saha Association of clinical signs of possible serious bacterial infections identified by community health workers with mortality of young infants in South Asia: a prospective, observational cohort studyResearch in context EClinicalMedicine Newborn Mortality Sepsis Possible serious bacterial infection Community health workers Integrated management of childhood illness |
| title | Association of clinical signs of possible serious bacterial infections identified by community health workers with mortality of young infants in South Asia: a prospective, observational cohort studyResearch in context |
| title_full | Association of clinical signs of possible serious bacterial infections identified by community health workers with mortality of young infants in South Asia: a prospective, observational cohort studyResearch in context |
| title_fullStr | Association of clinical signs of possible serious bacterial infections identified by community health workers with mortality of young infants in South Asia: a prospective, observational cohort studyResearch in context |
| title_full_unstemmed | Association of clinical signs of possible serious bacterial infections identified by community health workers with mortality of young infants in South Asia: a prospective, observational cohort studyResearch in context |
| title_short | Association of clinical signs of possible serious bacterial infections identified by community health workers with mortality of young infants in South Asia: a prospective, observational cohort studyResearch in context |
| title_sort | association of clinical signs of possible serious bacterial infections identified by community health workers with mortality of young infants in south asia a prospective observational cohort studyresearch in context |
| topic | Newborn Mortality Sepsis Possible serious bacterial infection Community health workers Integrated management of childhood illness |
| url | http://www.sciencedirect.com/science/article/pii/S2589537025000021 |
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