Simple Clinical Criteria to Identify Sepsis or Pneumonia in Neonates in the Community Needing Treatment or Referral

Abstract

These criteria identify neonates in the community who are at risk for dying of infection with excellent sensitivity, specificity and negative predictive value but a moderate positive predictive value. They can be used by health workers to select sick neonates for treatment or referral. One potentially fatal case would be treated per 4 presumptive cases treated.

Training birth attendants in rural Zambia in neonatal resuscitation, and the use of amoxicillin coupled with facilitated referral, reduces neonatal mortality

“…The incidence of possible severe bacterial infection (PSBI) (10.7%) is consistent with others' experience (10.6% in India1 and 13.1% in Nepal (P Dawson, personal communication)). Although underpowered to show decrease in cause-specific mortality, LUNESP may have reduced some infection deaths because of successful referral for optimal treatment or perhaps because of single high-dose oral amoxicillin.…”

Role of Acute Illness Observation Scale (AIOS) in managing severe childhood pneumonia

“…The compromised general status entailing various observation variables of AIOS had already shown to be a significant and independent predictor of serious illnesses including hypoxemia in respiratory tract infections in developing countries. 5,7,14 Importantly, all the three components of care envisaged in IMCI strategy can be upgraded by use of AIOS. First, the evidence based syndromic approach lays significant emphasis on evaluating severity of child's condition by primary care workers who usually misclassify symptoms with overlapping causes or for which a single diagnosis may not be appropriate using earlier vertical disease WHO algorithms.…”

“…4 An objective and graded appraisal of "clinical appearance" easily ascertainable by primary care givers, can be instrumental in influencing subsequent management decisions. [5][6][7] In this regard, use of Acute Illness Observation Scale (AIOS) -a generic illness severity scale-represents a distinctive paradigm drawing on simple observations (based on toxic appearance) instead of complex symptomatology, aiming for wholeness rather than details and encompassing the entire not just the ends of sickness continuum. 8,9 AIOS (a three-point scale for six ordinal variables and total score range of 6 to 30) is a validated clinical index of quantifying risk of serious bacterial infections (SBI) in children 36 months or younger presenting with febrile illnesses.…”

Home-Based Neonatal Care: Summary and Applications of the Field Trial in Rural Gadchiroli, India (1993 to 2003)

“…a simple and validated method of screening on the day of birth and identifying the neonates at high risk of death; 19 2. a simple and validated clinical method for identifying neonates with suspected sepsis; 20 3. algorithms for the home-based management of birth asphyxia, LBW or preterm babies and of sepsis; [21][22][23] 4. methods of health education to mothers/families for the adoption of better mother-newborn care practices; 24 5. selection of a village health worker (VHW), a resident literate woman in each village, as the provider of HBNC. A systematic method of selecting the appropriate woman as a VHW was developed; 6. a curriculum and the method of training VHWs (36 days of classroom training spread over a period of 12 months) including practicum periods in the community; 7. a mechanism of cooperation with TBAs; 8. a mix of social recognition, job satisfaction and performancebased remuneration to motivate the VHWs for a high level of performance.…”