Gates Open Research最新文献

{"title":"Using responsive feedback from routine monitoring data to guide course corrections for a family planning intervention in Nigeria","authors":"D. Meekers, O. Olutola, L. Abu Turk","doi":"10.12688/gatesopenres.14591.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14591.1","url":null,"abstract":"Background: This paper aims to promote the use of interrupted time series analyses of routine data as a responsive feedback tool to improve public health programs on an ongoing basis. This methodology is demonstrated by measuring the effect of a radio campaign to promote a family planning call center in Nigeria on the demand for family planning information and explains how the results were used to adapt the program.   Methods: We used a single group interrupted time series design (ITS) as a responsive feedback mechanism to determine whether the radio campaign influenced use of the Honey&Banana call center. ITS is ideal when a control group is not available and assumes that an interruption of the trend in the outcome measure occurs after the intervention starts. ITS uses the pre-intervention trend to predict what would have happened if the intervention were absent.   Results: After conducting ITS analyses, the results show that the number of calls requesting family planning information increased throughout the campaign period, with a gain of about 500 additional calls per month, and then decreased after the campaign ended. However, the number of calls gained from the campaign was substantially lower than anticipated.   Conclusions: While end-of-project impact evaluations are necessary, there should be regular feedback system to provide program implementers with information about the status of the project, such as failures, successes, and areas of improvements. This would allow implementers to make necessary adjustments as needed throughout the intervention period. The finding that the radio campaign was not living up to expectations helped program implementers to end the campaign prematurely and re-allocate resources to a more promising activity. Our research shows that basic ITS analysis of routine data can be a useful tool for receiving regular feedback to guide programming improvements.","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45159445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A study of the effectiveness of a detergent-based California mastitis test (CMT), using Ethiopian and Nigerian domestic detergents, for the detection of high somatic cell counts in milk and their reliability compared to the commercial UK CMT.","authors":"Jack D Rust, Michael J Christian, Ciara J Vance, Muhammed B Bolajoko, Johanna T Wong, Jeimmy Suarez-Martinez, Fiona K Allan, Andrew R Peters","doi":"10.12688/gatesopenres.13369.2","DOIUrl":"10.12688/gatesopenres.13369.2","url":null,"abstract":"<p><p><b>Background: </b> The California mastitis test (CMT) is a simple cow-side indicator of the somatic cell count (SCC) in milk, providing a useful tool in identifying cases of subclinical mastitis in cattle. Mastitis, and in particular subclinical mastitis, is a major concern in Ethiopia and Nigeria, yet detection is challenging due to cost and access to commercial CMT reagents. <b>Methods:</b> Commercially available domestic detergents from Ethiopia and Nigeria were compared (n = 3 for each country) with the UK commercial CMT reagent in their ability to detect high SCC (>400,000 cells/ml milk).  Sensitivity and specificity of the CMT test were calculated for the different detergents and positive and negative predictive values were established. <b>Results: </b> The average sensitivities of the tests ranged from 28-75% for the Ethiopian detergents and 68-80% for the Nigerian detergents, compared to 76% for the UK domestic detergent.  Test specificities were 84-98%, 93-97% and 96%, respectively. <b>Conclusions:</b> <b> </b>Overall, the detergents demonstrated higher specificity than sensitivity. <b> </b> Nigerian detergents performed better than the Ethiopian products, however, the study identified suitable domestic detergents from both Ethiopia and Nigeria, comparable to the UK commercial CMT reagent, and we recommend their use as alternative CMT reagents for livestock-keepers to aid in cost-effective diagnosis of mastitis.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"5 ","pages":"146"},"PeriodicalIF":0.0,"publicationDate":"2023-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10285044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10093957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Azithromycin in labour to reduce maternal and newborn sepsis and associated deaths: the need for a harmonized approach","authors":"E. Mcclure, A. Roca, K. Kotloff, W. Carlo, U. d’Alessandro, H. Tinto, Bully Camara, E. Chomba, S. Sow, A. Driscoll, J. Hemingway-Foday, A. Tita","doi":"10.12688/gatesopenres.14214.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14214.1","url":null,"abstract":"Maternal and newborn infections are a major contributor to mortality and morbidity globally.  Lost-cost, effective and safe interventions are needed to address these.  Based on promising findings, azithromycin has been identified as potentially effective antibiotic to reduce maternal and newborn infections in low- and middle-income countries (LMICs).  However, robust randomized clinical trials in a range of settings are needed to confirm these findings as well as to understand the implications for antimicrobial resistance.  To better understand the impact of azithromycin on maternal and newborn health, at least three clinical trials are being conducted to evaluate azithromycin in LMICs.  We describe these trials, the importance of harmonizing study measures and the potential public health impact of azithromycin in LMICs.","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48798542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implication of the 2014 World Health Organization Integrated Management of Childhood Illness Pneumonia Guidelines with and without pulse oximetry use in Malawi: A retrospective cohort study","authors":"S. Hooli, C. Makwenda, N. Lufesi, T. Colbourn, T. Mvalo, E. McCollum, C. King","doi":"10.12688/gatesopenres.13963.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.13963.1","url":null,"abstract":"Background: Under-5 pneumonia mortality remains high in low-income countries. In 2014 the World Health Organization (WHO) advised that children with chest indrawing pneumonia, but without danger signs or peripheral oxygen saturation (SpO2) < 90% be treated in the community, rather than hospitalized. In Malawi there is limited pulse oximetry availability. Methods: Secondary analysis of 13,413 under-5 pneumonia cases in Malawi. Pneumonia associated case fatality ratios (CFR) were calculated by disease severity under the assumptions of the 2005 and 2014 WHO Integrated Management of Childhood Illness (IMCI) guidelines, with and without pulse oximetry. We investigated if pulse oximetry readings were missing not at random (MNAR). Results: The CFR of patients classified as having non-severe pneumonia per the 2014 IMCI guidelines doubled under the assumption that pulse oximetry was not available (1.5% without pulse oximetry vs 0.7% with pulse oximetry, P<0.001). When 2014 IMCI guidelines were applied with pulse oximetry and a SpO2 < 90% as the threshold for referral and/or admission, the number of cases meeting hospitalization criteria decreased by 70.3%. Unrecorded pulse oximetry readings were MNAR with an adjusted odds for mortality of 4.9 (3.8, 6.3), similar to that of a SpO2 < 90%. Although fewer girls were hospitalized, female sex was an independent mortality risk factor. Conclusions: In Malawi, implementation of the 2014 WHO IMCI pneumonia guidelines, without pulse oximetry, will miss high risk cases. Alternatively, implementation of pulse oximetry may result in a large reduction in hospitalization rates without significantly increasing non-severe pneumonia associated CFR if the inability to obtain a pulse oximetry reading is considered a WHO danger sign.","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49196858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using models and maps to inform Target Product Profiles and Preferred Product Characteristics: the example of Wolbachia replacement","authors":"Katie Tiley, J. Entwistle, Bruce Thomas, L. Yakob, O. Brady","doi":"10.12688/gatesopenres.14300.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14300.1","url":null,"abstract":"Background The global prevalence of diseases transmitted by Aedes aegypti mosquitoes, such as dengue, Zika and Yellow Fever, is increasing, but development of promising new mosquito control technologies could reverse this trend. Target Product Profiles (TPPs) and Preferred Product Characteristics (PPCs) documents issued by the World Health Organization can guide the research and development pathways of new products and product combinations transitioning from proof of concept to operational use. Methods We used high resolution global maps of the case and economic burden of dengue to derive programmatic cost targets to support a TPP for Wolbachia replacement. A compartmental entomological model was used to explore how release size, spacing and timing affect replacement speed and acceptability. To support a PPC for a hybrid suppress-then-replace approach we tested whether Wolbachia replacement could be achieved faster, more acceptably or at a lower cost if preceded by a mosquito suppression programme. Results We show how models can reveal trade-offs, identify quantitative thresholds and prioritise areas and intervention strategies for further development. We estimate that for Wolbachia replacement to be deployable in enough areas to make major contributions to reducing global dengue burden by 25% (in line with 2030 WHO targets), cost must ultimately be reduced to between $7.63 and $0.24 (USD) per person protected or less. Suppression, particularly interventions that induce mosquito sterility, can reduce the number of Wolbachia mosquitoes necessary to achieve fixation by up to 80%. A hybrid approach can also achieve fixation faster and potentially improve acceptability, but may not justify their cost if they require major new investments in suppression technologies. Conclusions Here we demonstrate the value dedicated modelling can provide for interdisciplinary groups of experts when developing TPPs and PPCs. These models could be used by product developers to prioritise and shape development decisions for new Wolbachia replacement products.","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41542373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tranexamic acid for the prevention of postpartum bleeding in women with anaemia: Statistical analysis plan for the WOMAN-2 trial: an international, randomised, placebo-controlled trial","authors":"Tim Collier, Haleema Shakur-Still, Ian Roberts, Eni Balogun, Oladapo Olayemi, Folasade Adenike Bello, Rizwana Chaudhri, Projestine Muganyizi","doi":"10.12688/gatesopenres.14529.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14529.1","url":null,"abstract":"<ns4:p><ns4:bold>Background: </ns4:bold>Postpartum haemorrhage (PPH) is responsible for over 50,000 maternal deaths every year. Most of these deaths are in low- and middle-income countries. Tranexamic acid (TXA) reduces bleeding by inhibiting the enzymatic breakdown of fibrin blood clots. TXA decreases surgical bleeding and reduces deaths from bleeding after traumatic injury. When given within three hours of birth, TXA reduces deaths from bleeding in women with PPH. However, for many women, treatment of PPH is too late to prevent death. World-wide, over one-third of pregnant women are anaemic and many are severely anaemic. These women have an increased risk of PPH and are more likely to die if PPH occurs. There is an urgent need to identify ways to prevent severe postpartum bleeding in anaemic women. The WOMAN-2 trial will quantify the effects of TXA on postpartum bleeding in women with anaemia.</ns4:p><ns4:p> <ns4:bold>Results: </ns4:bold>This statistical analysis plan (version 1.0; dated 22 February 2023) has been written based on information in the WOMAN-2 Trial protocol version 2.0, dated 30 June 2022. The primary outcome of the WOMAN-2 trial is the proportion of women with a clinical diagnosis of primary PPH. Secondary outcomes are maternal blood loss and its consequences (estimated blood loss, haemoglobin, haemodynamic instability, blood transfusion, signs of shock, use of interventions to control bleeding); maternal health and wellbeing (fatigue, headache, dizziness, palpitations, breathlessness, exercise tolerance, ability to care for her baby, health related quality of life, breastfeeding); and other health outcomes (deaths, vascular occlusive events, organ dysfunction, sepsis, side effects, time spent in higher level facility, length of hospital stay, and status of the baby).</ns4:p><ns4:p> <ns4:bold>Conclusions: </ns4:bold>WOMAN-2 will provide reliable evidence about the effects of TXA in women with anaemia.</ns4:p><ns4:p> <ns4:bold>Registration: </ns4:bold>WOMAN-2 was prospectively registered at the International Standard Randomised Controlled Trials registry (<ns4:ext-link xmlns:ns5=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" ns5:href=\"https://www.isrctn.com/ISRCTN62396133\">ISRCTN62396133</ns4:ext-link>) on 07/12/2017 and ClinicalTrials.gov on 23/03/2018 (<ns4:ext-link xmlns:ns5=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" ns5:href=\"https://clinicaltrials.gov/ct2/show/NCT03475342\">NCT03475342</ns4:ext-link>).</ns4:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135389185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The more, the better: influence of family planning discussions during the maternal, newborn and child health continuum of care on postpartum contraceptive uptake and method type among young women in Ethiopia.","authors":"Lisa M Calhoun, Jennifer Winston, Lenka Beňová, Ilene S Speizer, Thérèse Delvaux, Solomon Shiferaw, Assefa Seme, Celia Karp, Linnea Zimmerman, Thomas van den Akker","doi":"10.12688/gatesopenres.14626.1","DOIUrl":"10.12688/gatesopenres.14626.1","url":null,"abstract":"<p><p><b>Background:</b> This study examines the association between family planning (FP) discussions with health professionals during contact points on the maternal, newborn and child health continuum of care and timing of modern contraceptive uptake and method type in the one-year following childbirth in six regions of Ethiopia among adolescent girls and young women (AGYW). <b>Methods</b>: This paper uses panel data of women aged 15-24 who were interviewed during pregnancy and the postpartum period between 2019-2021 as part of the PMA Ethiopia survey (n=652).  <b>Results</b>: Despite the majority of pregnant and postpartum AGYW attending antenatal care (ANC), giving birth in a health facility, and attending vaccination visits, one-third or less of those who received the service reported discussion of FP at any of these visits. When considering the cumulative effect of discussions of FP at ANC, pre-discharge after childbirth, postnatal care and vaccination visits, we found that discussion of FP at a greater number of visits resulted in increased uptake of modern contraception by one-year postpartum. A greater number of FP discussions was associated with higher long-acting reversible contraceptive use relative to non-use and relative to short-acting method use. <b>Conclusions</b>: Despite high attendance, there are missed opportunities to discuss FP when AGYW access care.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"7 ","pages":"67"},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10323130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10168739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits, anxieties, acceptance, and barriers to the new injectable contraceptive DMPA-SC (Sayana Press): Clients’ perceptions in Sindh, Pakistan","authors":"Ghulam Yaseen Veesar, T. Lashari, Roshan Fida, M. A. Veesar","doi":"10.12688/gatesopenres.14326.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14326.1","url":null,"abstract":"Background: Injections are Pakistan's third most preferred contraceptive method because of their convenience. They represent a 2.5% share of the contraceptive prevalence rate (CPR) and contribute 10% to the current CPR. However, injections require a clinical setting or a healthcare provider for administration. A new method of subcutaneous presentation of depot medroxyprogesterone acetate (DMPA-SC), namely Sayana Press in Uniject™, has been introduced, which can be administered in nonclinical settings or self-administered by trained women. This study examined clients’ perceptions of the current depot medroxyprogesterone acetate-intramuscular injection (DMPA-IM) and its accessibility, availability, affordability, advantages, and disadvantages. In addition, it explored the benefits, barriers, and challenges regarding the new method of DMPA-SC (Sayana Press), especially considering self-injection. Methods: The study was conducted in Sindh, Pakistan. Three focus group discussions were conducted with 9–13 female participants with different demographic characteristics. A semi-structured questionnaire was used. The discussion was recorded, transcribed, and translated from Urdu or Sindhi to English. Transcripts were coded precisely, and data analysis was performed using NVivo software. Results: Participants expressed moderate fear of self-injection and risk of an inaccurate prick, suggesting that DMPA-SC acceptance may not be challenging at a community level. They appreciated free services at public health facilities, as the affordability of private facilities may be challenging for those with low income. Most participants agreed to pay PKR 50–300 (approximately 1 USD or less) as service charges for a private facility, while some agreed to pay for transportation costs when lacking alternative methods. Conclusions: DMPA-SC is a valuable alternative, provided its challenges are adequately addressed. Information about self-injection contraceptives is currently limited, and shared self-administration may be difficult without adequate training and counseling. Nevertheless, clients prefer the self-injection method for family planning to avoid transportation and private service charges.","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43446083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Uptake of same-day initiation of HIV treatment in Malawi, South Africa, and Zambia as reported in routinely collected data: the SPRINT retrospective cohort study.","authors":"Amy Huber, Kamban Hirasen, Alana T Brennan, Bevis Phiri, Timothy Tcherini, Lloyd Mulenga, Prudence Haimbe, Hilda Shakwelele, Rose Nyirenda, Bilaal Wilson Matola, Andrews Gunda, Sydney Rosen","doi":"10.12688/gatesopenres.14424.2","DOIUrl":"10.12688/gatesopenres.14424.2","url":null,"abstract":"<p><p><b>Background:</b> Since 2017 global guidelines have recommended \"same-day initiation\" (SDI) of antiretroviral treatment (ART) for patients considered ready for treatment on the day of HIV diagnosis. Many countries have incorporated a SDI option into national guidelines, but SDI uptake is not well documented. We estimated average time to ART initiation at 12 public healthcare facilities in Malawi, five in South Africa, and 12 in Zambia. <b>Methods:</b> We identified patients eligible to start ART between January 2018 and June 2019 from facility testing registers and reviewed their medical records from HIV diagnosis to the earlier date of treatment initiation or 6 months. We estimated the proportion of patients initiating ART on the same day or within 7, 14, 30, or 180 days of baseline. <b>Results:</b> We enrolled 825 patients in Malawi, 534 in South Africa, and 1,984 in Zambia. Overall, 88% of patients in Malawi, 57% in South Africa, and 91% in Zambia received SDI. In Malawi, most who did not receive SDI had not initiated ART ≤6 months. In South Africa, an additional 13% initiated ≤1 week, but 21% had no record of initiation ≤6 months. Among those who did initiate within 6 months in Zambia, most started ≤1 week. There were no major differences by sex. WHO Stage III/IV and tuberculosis symptoms were associated with delays in ART initiation;  clinic size and having a CD4 count done were associated with an increased likelihood of SDI. <b>Conclusions:</b> As of 2020, SDI of ART was widespread, if not nearly universal, in Malawi and Zambia but considerably less common in South Africa. Limitations of the study include pre-COVID-19 data that do not reflect pandemic adaptations and potentially missing data for Zambia. South Africa may be able to increase overall ART coverage by reducing numbers of patients who do not initiate ≤6 months.</p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":"7 ","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2023-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10160348.2/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9466571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community health worker-led household screening and management of neonatal hyperbilirubinemia in rural Bangladesh: a cluster randomized control trial protocol","authors":"E. Foote, Farjana Jahan, Md. Mahbubur Rahman, S. Parvez, Tasnim Ahmed, Rezaul Hasan, F. Yeasmin, S. Arifeen, S. M. Billah, M. Hoque, Mohammad L. Shahidullah, Md. Shariful Islam, V. Bhutani, G. Darmstadt","doi":"10.12688/gatesopenres.14033.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14033.1","url":null,"abstract":"Background: Extreme hyperbilirubinemia leading to neurologic disability and death is disproportionately high in low to middle income countries (LMIC) such as Bangladesh, and is largely preventable through timely treatment. Of the estimated 50% of newborns born in LMICs born at home, few receive screening or treatment for hyperbilirubinemia, leading to 6 million newborns per year who need phototherapy treatment for hyperbilirubinemia but are untreated. Household screening and treatment for neonatal hyperbilirubinemia with phototherapy administered by a trained community health worker (CHW) may increase indicated treatment for neonatal hyperbilirubinemia in comparison to the existing care system in Bangladesh. Methods: 530 Bangladeshi women in their 2nd or 3rd trimester of pregnancy from the rural community of Sakhipur, Bangladesh will be recruited for a cluster randomized trial and randomized to the intervention arm — home screening and treatment for neonatal hyperbilirubinemia — or the comparison arm to receive usual care. In the intervention arm, CHWs will provide mothers with two prenatal visits, visit newborns by 2 days of age and then daily for 3 days to measure transcutaneous bilirubin (TcB) and monitor clinical danger signs. Newborns without danger signs but with a TcB above the treatment threshold <15 mg/dL will be treated with light-emitting diode (LED) phototherapy at home. Newborns with danger signs or TcB >15 mg/dL will be referred to a hospital for treatment. Treatment rates for neonatal hyperbilirubinemia in each arm will be compared. Conclusion: This study will evaluate the effectiveness of CHW-led home phototherapy to increase neonatal hyperbilirubinemia treatment rates in rural Bangladesh. LMICs are expanding access to postnatal care by using CHWs, and our work will give CHWs a curative treatment option for neonatal hyperbilirubinemia. Similar projects in other LMICs can be pursued to dramatically extend healthcare access to vulnerable newborns with hyperbilirubinemia.","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48352132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}