Table 2. Identification, classification, treatment accepted, completion of treatment and treatment outcome for Infants 0–59 days with PSBI.
| Parameters | Infant 0–59 days with PSBI | Infants 7–59 days of age with fast breathing only4 (Pneumonia) | Infants 0–6 days with fast breathing only3 (Severe pneumonia) | Infants 0–59 days with clinical severe infection2 | Infants 0–59 days with critical illness1 | |||||
|---|---|---|---|---|---|---|---|---|---|---|
| A. Identification | (n = 160) | (n = 34) | (n = 5) | (n = 92) | (n = 29) | |||||
| Born in health facility, healthy at birth and identified as having PSBI before discharge | 40 (25) | 0 | 3 (60) | 33 (36) | 4 (14) | |||||
| Brought by families to health facility | 75 (47) | 20 (59) | 1 (20) | 35 (38) | 19 (65) | |||||
| Identified by or referred to health facility by any community health workers | 45 (28) | 14 (41) | 1 (20) | 24 (26) | 6 (21) | |||||
| By ASHAs | 44 (27) | 14 (41) | 1 (20) | 23 (25) | 6 (21) | |||||
| By ANM | 1 (1) | 0 | 0 | 1 (1) | 0 | |||||
| B. Referral History | (n = 130) | (n = 4)7 | (n = 5) | (n = 92) | (n = 29) | |||||
| Referral offered to a health care facility with pediatric services5 | 130 | 4 | 5 | 92 | 29 | |||||
| Refused referral | 82 (63) | 3 (75) | 3 (60) | 65 (71) | 11 (38) | |||||
| Accepted referral | 48 (37) | 1 (25) | 2 (40) | 27 (29) | 18 (62) | |||||
| C. Simplified Treatment given at first level health facility (SC, PHC, CHC)6 | (n = 112) | (n = 33) | (n = 3) | (n = 65) | (n = 11) | |||||
| Received 7 injections of gentamicin and 14 doses of suspension amoxicillin | 50 (45) | 16 (48) | 2 (67) | 34 (52) | 4 (36)8 | |||||
| D. Compliance to treatment | (n = 112) | (n = 33)9 | (n = 3) | (n = 65) | (n = 11) | |||||
| Amoxicillin Suspension Received | ||||||||||
| 14 doses | 60 (53) | 17 (51) | 2 (67) | 37 (57) | 4 (36) | |||||
| 10–13 doses | 13 (20) | 4 (12) | 0 | 5 (8) | 4 (36) | |||||
| 1–9 doses | 13(20) | 5 (15) | 1 (33) | 5 (8) | 2 (18) | |||||
| None (not advised) | 26 (40) | 7 (21) | 0 | 18 (28) | 1 (9) | |||||
| Additional antibiotics received | 21 (19) | 7 (21) | 1 (33) | 12 (18) | 1 (9) | |||||
| Injection gentamicin Received | ||||||||||
| 7 injections | 63 (56) | 16 (48) | 3 (100) | 39 (60) | 5 (45) | |||||
| 1–6 injections | 38 (58) | 10 (30) | 0 | 23 (35) | 5 (45) | |||||
| No injection (not advised) | 11 (17) | 7 (21) | 0 | 3 (5) | 1 (9) | |||||
| E. Follow up | N | n (%) | N | n (%) | N | n (%) | N | n (%) | N | n (%) |
| Day 4 in all PSBI cases by health worker | 160 | 118 (74) | 34 | 20 (59) | 5 | 5 (100) | 92 | 70 (76) | 29 | 23 (79) |
| On Day 4 in cases who received simplified treatment given at first level health facility | 112 | 86 (77) | 33 | 19 (57) | 3 | 3 (100) | 65 | 55 (85) | 11 | 9 (82) |
| On Day 4 in cases who accepted referral to a hospital with pediatric care facility | 48 | 32 (67) | 1 | 1 (100) | 2 | 2 (100) | 27 | 15 (55) | 18 | 14 (78) |
| Day 8 follow up by research team for final outcome assessment | 160 | 159 (99) | 34 | 34 (100) | 5 | 5 (100) | 92 | 92 (100) | 29 | 28 (96) |
|
F. Outcome of the illness i) In all PSBI cases identified |
(n = 160) | (n = 34) | (n = 5) | (n = 92) | (n = 29) | |||||
| Recovered | 146 (91) | 29 (85) | 5 (100) | 86 (93) | 26 (90) | |||||
| Treatment failure10 | 14 (9) | 5 (15) | 0 | 6 (7) | 3 (10) | |||||
| Severe adverse reaction | 2 (1) | 1 (3) | 0 | 1 (1) | 0 | |||||
| Clinical deterioration | 2 (1) | 1 (3) | 0 | 1 (1) | 0 | |||||
| Persistence | 4 (2) | 1 (3) | 0 | 3 (3) | 0 | |||||
| Death | 6 (4) | 2 (6) | 0 | 1 (1) | 3 (10) | |||||
| ii) Outcomes in those who received simplified treatment at the first level health facility | (n = 112) | (n = 33) | (n = 3) | (n = 65) | (n = 11) | |||||
| Recovered | 103 (92) | 28 (85) | 3 (100) | 61 (94) | 11 (100) | |||||
| Treatment failure10 | 9 (8) | 5 (15) | 0 | 4 (6) | 0 | |||||
| Severe adverse reaction | 2 (2) | 1 (3) | 0 | 1 (1) | 0 | |||||
| Clinical deterioration | 1 (1) | 1 (3) | 0 | 0 | 0 | |||||
| Persistence | 4 (3) | 1 (3) | 0 | 3 (5) | 0 | |||||
| Death | 2 (2) | 2 (6) | 0 | 0 | 0 | |||||
| iii) Outcomes in those who accepted referral and were treated in a hospital with pediatric care facility | (n = 48) | (n = 1) | (n = 2) | (n = 27) | (n = 18) | |||||
| Recovered | 43 (89) | 1 (100) | 2 (100) | 25 (92) | 15 (83) | |||||
| Treatment failure10 | 5 (10) | 0 | 0 | 2 (7) | 3 (17) | |||||
| Severe adverse reaction | 0 | 0 | 0 | 0 | 0 | |||||
| Clinical deterioration | 1 (2) | 0 | 0 | 1 (4) | 0 | |||||
| Persistence | 0 | 0 | 0 | 0 | 0 | |||||
| Death | 4 (8) | 0 | 0 | 1 (4) | 3 (17) | |||||
1Critical illness defined as having any of the following signs: Not able to feed, Convulsions, No movement
2 Clinical severe infection defined as having any of the following signs: Stopped feeding well, movement only when stimulated, severe chest indrawing, Axillary Temp ≥ 37.5° C or < 35.5° C
3Severe Pneumonia defined as having: Fast Breathing, ≥ 60/min in age 0–6 days
4Pneumonia defined as having: Fast Breathing, ≥ 60/min in age 7–59 days
5 Referral was offered to all cases of CSI, CI and SP to a hospital with pediatric care facility (DH/GH/Medical College). In addition, 4 cases of pneumonia were referred as per clinical judgement of the medical officer and 1 of them accepted referral
6Includes all cases who refused referral to a hospital with pediatric care facility and remaining 30 cases of pneumonia
7These children were offered referral as per clinical judgement by the medical officer though it is not recommended to refer these cases; 1 of them accepted referral and was treated in a higher facility; pre-referral dose was given and infant recovered.
8No infant with CI received Injection Ampicillin
97 cases received only amoxicillin without any other injectable, 19 cases received inj. gentamicin along with amoxicillin, although they were not supposed to, 7 cases received injection gentamicin, but did not receive oral amoxicillin
10Treatment failure: An infant with PSBI with following outcomes: Death, Clinical deterioration defined as emergence of any sign of critical illness, any new sign of severe infection, need for care at higher level (hospitalization) during treatment, Persistence defined as no improvement by day 4 or not fully recovered by day 8, Severe adverse reaction due to antibiotic administered as per simplified regimen