Possible Severe Bacterial infection (PSBI) Allisyn Moran, WHO/MCA - - PowerPoint PPT Presentation

Allisyn Moran, WHO/MCA

30 May 2019

Global Overview of Measurement of Possible Severe Bacterial infection (PSBI)

Outline of Presentation

• Burden of neonatal sepsis
• Suggested indicators for PSBI monitoring
• Challenges and next steps

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Postneonatal Leading causes of postneonatal deaths are acute respiratory infections, diarrhoea, other infections, injuries and malaria Leading causes of neonatal deaths are prematurity, birth asphyxia, sepsis and congenital anomalies

Global causes of under-five death, 2017

Neonatal (47%)

ENAP Milestones regarding measurement

• Count births and deaths in CVRS and surveys (women, newborns and stillbirths)
• Every newborn core indicators to be defined , incorporated in national metrics platforms and used
• Perinatal mortality audit and minimum dataset being widely used

Every Newborn measurement improvement roadmap

5 year plan with >80 partners Led by WHO with LSHTM

2030

End Preventabl e Maternal and Newborn Deaths including Stillbirths Effective use of data in national health informatio n systems

2020

5 INDEPTH sites (65,000 births) with randomised comparison of survey modules to improve survey methods to capture SBR, NMR, birthweight, GA EN-BIRTH STUDY EN-SMILING STUDY INDEPTH STUDY Facility births (20,000) in Bangladesh, Nepal, Tanzania validating indicators for rhesus, KMC, neonatal infection treatment, ACS, uterotonic use Follow up EN-BIRTH newborns in Bangladesh, Nepal, Tanzania to test simpler child development metrics, assess ECD outcomes after basic neonatal care SMALL & SICK NEWBORNS Define content, competencies for care of small and sick newborns, compare data platforms, develop std HFA content, barriers/enablers to data collection

Current Status Core Indicators Additional indicators

Definitions clear but quantity & consistency of data lacking

IMPACT

• 1. Maternal mortality ratio
• 2. Stillbirth rate

Intrapartum stillbirth rate

• 3. Neonatal mortality rate

Low birth weight rate Preterm birth rate Small for gestational age Neonatal morbidity rates Disability after neonatal conditions

Contact point definitions clear but data on content of care are lacking

COVERAGE

Care for all mothers and newborns

• 4. Skilled attendant at birth
• 5. Early postnatal care for mothers & babies
• 6. Essential newborn care (tracer, early

breastfeeding)

Antenatal Care Exclusive breastfeeding to 6 months

Gaps in definitions, requiring validation and feasibility testing for HMIS use

COVERAGE

Complications and extra care

• 7. Neonatal resuscitation
• 8. Kangaroo mother care

Caesarean section rate

• 9. Treatment of serious neonatal infections
• 10. Antenatal corticosteroid use

Chlorhexidine cord cleansing

INPUT

Service readiness for Quality of Care

Emergency Obstetric Care Care of Small and Sick Newborns Quality of care with measurable norms and standards COUNTING Birth Registration

Death registration, cause of death

Every Newborn Action Plan Indicators

Shaded= Not currently routinely tracked at global level Bold red= Indicator requiring additional testing to inform consistent measurement Adapted from Every Newborn Action Plan. WHO, 2014. www.everynewborn.org and Mason et al Lancet 2014

Coverage indicators

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ENAP - Treatment of Severe Neonatal infection

Process indicator: Numerator: Number of facilities in which gentamicin is available at suitable peripheral level for treatment of severe neonatal infection Denominator: Number of facilities assessed Data source: Health facility assessment Coverage indicator: Numerator: Number of newborns that received at least on dose of antibiotic injection for PSBI in the facility Denominator: a) Live births in the facility; b) Total births in the facility; c) Estimated births (live or total); d) Target population for coverage (newborns diagnosed with PSBI in target population)

5/29/2019 Source: Moxon et al, BMC Pregnancy and Childbirth, 2015 7

Challenges

• PSBI indicators mostly collected in research settings, with supplemental

data collection efforts

• Newborns are treated in different locations – different registers
• Many countries have aggregate data - not possible to track multiple

treatments over time

• EN BIRTH study – what to collect through routine information settings

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