Traditional Birth Attendants Can Help Treat Neonatal Sepsis
The strategy of relying on traditional birth attendants, or community midwifes, to treat neonatal sepsis with a dose of antibiotics and refer infants to health clinics is feasible and could be effective in reducing mortality in remote rural settings, a new BU study has found.
The study, led by School of Public Health researchers with the BU Center for Global Health & Development, found that despite having limited training, the birth attendants (TBAs) were able to “accurately identify critically ill neonates, initiate treatment in the field, and refer for further care.
The findings, published in the journal Global Health: Science and Practice, are the latest results from a long-running BU study in Zambia known as LUNESP, which trains women in the community to care for mothers and newborns. In rural Zambia, as in other remote areas with limited access to health care, neonatal sepsis is a major cause of mortality. Early identification of bacterial infections and initiation of antibiotics by community health workers is critical to saving newborns’ lives.
In past studies, LUNESP trainings and interventions by TBAs have been found to reduce all-cause, 28-day mortality among live-born babies by nearly half, with the largest reductions during the first 48 hours of life.
The new results found that infants deemed ‘extremely sick’ by the TBAs, and who therefore were targeted for the intervention, were nearly nine times more likely to die than infants deemed well by the TBAs. This indicates that even health workers with very basic educational backgrounds and limited medical skills can be trained to accurately identify sick infants and initiate appropriate therapy, the authors said.
The findings raise the possibility that the receiving health clinics may have been insufficiently prepared to handle neonatal sepsis, the authors said, suggesting that resources could be focused on strengthening those providers, or on increasing the capacity of the TBAs themselves to manage the illness.
Regardless, the researchers said, “We conclude that the TBAs demonstrated sound clinical judgment and reacted according to their training, which strongly supports the feasibility of using TBAs in this role.”
Authors on the study included: Christopher Gill, William MacLeod, Anna Knapp and Davidson Hamer from BUSPH; Nicholas Guerina from Women and Neonates Hospital in Rhode Island; Mark Mirochnick from the BU School of Medicine; and Grace Phiri-Mazala from the Zambia Anglican Council.
Submitted by: Lisa Chedekel