Perceptions of Health Care Providers and the Community on the Management of Possible Serious Bacterial Infection (PSBI) in Young Infants where Referral is not Possible: A Qualitative Study

Abstract

Introduction: Every year, about 2.8 million children die in the first month of life, with 98% of these deaths occurring in developing countries. The current World Health Organization recommendation for management of infections in neonates and young infants (0–59 days old) is referral for hospital treatment with a 7 to 10 day course of a combination of two injectable antibiotics – Penicillin or Ampicillin plus Gentamicin. However, existing evidence demonstrates that in resource-limited settings many young infants with signs of Possible Serious Bacterial Infection (PSBI) do not receive the recommended inpatient treatment because such treatment is not accessible, acceptable or affordable to families. Therefore, in-depth understanding the process of the implementation of community based management of sick young infants will contribute to increase the access to quality care and improving the outcomes for sick young infants.
Objective: The aim of this study was to explore the perceptions of health care providers and the community on managing possible serious bacterial infection in young infants where referral is not possible in Tigray, Northern Ethiopia.
Methods: We conducted a qualitative study on July, 2016 in Raya Azebo and Raya Alamata districts in Tigray, Northern Ethiopia. We enrolled 14 Focus Group Discussions (FGDs) and 57 In-depth Interviews (IDIs) from the community and health care providers using a purposive sampling method. Interview guides were prepared ahead of time. Data were collected by experienced and trained public health professionals. The interview was tape recorded and transcribed. Transcript was thematically analyzed using Atlas-ti software. Results regarding anticipated barriers and facilitators to the implementation research were summarized. Results: A total of 197 participants were involved in the individual and group interview. The study participants consistently stated the following barriers to the implementation of community based management of PSBI in sick young infants: (1) Lack of awareness of service availability of PSBI management at the level of the health post; (2) Large area, topography and transportation problem for the mothers to reach the health post; (3) High turnover of Health Extension Workers (HEW); (4) inconvenience of the opening time of the health post. The facilitators for the implementation process were: (1) HEWs acceptance by community; (2) improvement of community knowledge on common new born health problem; (3) having a moderate knowledge on services provided by the HEWs; and (4) a good community practice towards care of the newborn.
Conclusion: Strengthening community mobilization and sensitization through the available political system on issues related to the community based management of sick young infants and increasing the number of the HEWs would add value to scale-up the ongoing implementation research.
Keywords: Qualitative, implementation research, PSBI, HEW

Cite this Article
Abadi Luel, Alemayehu Byaray, Afework Mulugeta et al. Perceptions of Health Care Providers and the Community on the Management of Possible Serious Bacterial Infection (PSBI) in Young Infants where Referral is not Possible: A Qualitative Study. Research & Reviews: A Journal of Immunology. 2017; 7(3): 23–28p.