In Ethiopia, neonatal mortality accounts for approximately 54% of under-five deaths with the majority of these deaths driven by infections. Possible Severe Bacterial Infection (PSBI) in neonates is a syndromic diagnosis that non-clinical health care providers use to identify and treat newborns with signs of sepsis. In low- and middle–income countries, referral to a hospital may not be feasible due to transportation, distance or finances. Growing evidence suggests health extension workers (HEWs) can identify and manage PSBI at the community level when referral to a hospital is not possible. However, community-based PSBI care strategies have not been widely scaled-up. This study aims to understand general determinants of household-level care as well as household care seeking and decision-making strategies for neonatal PSBI symptoms. We conducted eleven focus group discussions (FGDs) to explore illness recognition and care seeking intentions from four rural kebeles in Amhara, Ethiopia. FGDs were conducted among mothers, fathers and households with recruitment stratified among households that have had a newborn with at least one symptom of PSBI (Symptomatic Group), and households that have had a newborn regardless of the child’s health status (Community Group). Data were thematically analyzed using MAXQDA software. Mothers were described as primary caretakers of the newborn and were often appreciated for making decisions for treatment, even when the father was not present. Type of care accessed was often dependent on conceptualization of the illness as simple or complex. When symptoms were not relieved with clinical care, or treatments at facilities were perceived as ineffective, alternative methods were sought. Most participants identified the health center as a reliable facility. While designed to be the first point of access for primary care, health posts were not mentioned as locations where families seek clinical treatment. This study describes socio-contextual drivers for PSBI treatment at the community level. Future programming should consider the role community members have in planning interventions to increase demand for neonatal care at primary facilities. Encouragement of health post utilization could further allow for heightened accessibility-acceptability of a simplified PSBI regimen.

中文翻译：

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在埃塞俄比亚阿姆哈拉寻找可能的严重细菌感染（PSBI）的新生儿护理和社区级治疗

在埃塞俄比亚，新生儿死亡率约占五岁以下儿童死亡的54％，其中大多数死亡是由感染引起的。新生儿中可能的严重细菌感染（PSBI）是一种综合症状诊断，非临床医疗保健人员可用来鉴定和治疗患有败血症迹象的新生儿。在中低收入国家/地区，由于交通，距离或经济原因，转诊到医院可能不可行。越来越多的证据表明，当不可能转诊到医院时，健康推广人员（HEW）可以在社区一级识别和管理PSBI。但是，基于社区的PSBI护理策略尚未得到广泛推广。这项研究旨在了解家庭级护理的一般决定因素以及新生儿PSBI症状的家庭护理寻求和决策策略。我们进行了11次焦点小组讨论（FGD），以探讨来自埃塞俄比亚阿姆哈拉（Amhara）的四个农村小骨的疾病识别和寻求治疗的意图。FGDs在母亲，父亲和家庭中进行，招募对象是新生儿（至少有PSBI症状）的家庭（有症状的组）和新生儿（与孩子的健康状况无关）的家庭（社区组）。使用MAXQDA软件对数据进行专题分析。母亲被描述为新生儿的主要护理者，即使父亲不在场，他们也常常因做出治疗决定而受到赞赏。获得的护理类型通常取决于对疾病的概念是简单还是复杂。如果临床治疗无法缓解症状，或认为设施的治疗无效，寻求替代方法。大多数参与者认为卫生中心是可靠的设施。虽然被设计成是初级保健的第一通路，但没有提到卫生站是家庭寻求临床治疗的地点。这项研究描述了社区层面PSBI治疗的社会背景驱动因素。未来的计划应考虑社区成员在计划干预措施以增加对基础设施新生儿护理需求方面的作用。鼓励卫生后利用，可以进一步简化PSBI方案的可及性。没有提到卫生站是家庭寻求临床治疗的地点。这项研究描述了社区层面PSBI治疗的社会背景驱动因素。未来的计划应考虑社区成员在计划干预措施以增加对基础设施新生儿护理需求方面的作用。鼓励卫生后利用，可以进一步简化PSBI方案的可及性。没有提到卫生站是家庭寻求临床治疗的地点。这项研究描述了社区层面PSBI治疗的社会背景驱动因素。未来的计划应考虑社区成员在计划干预措施以增加对基础设施新生儿护理需求方面的作用。鼓励卫生后利用，可以进一步简化PSBI方案的可及性。