{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T18:45:46Z","timestamp":1789584346589,"version":"build-2803163510"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization","award":["OPP1114815"],"award-info":[{"award-number":["OPP1114815"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,14]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The objective was to achieve high coverage of possible serious bacterial infections (PSBI) treatment using the World Health Organization (WHO) guideline for managing it on an outpatient basis when referral to a hospital is not feasible.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We implemented this guideline in the programme settings at 10 Basic Health Units (BHU) in two rural districts of Sindh in Pakistan using implementation research. A Technical Support Unit supported the programme to operationalize guidelines, built capacity of health workers through training, monitored their clinical skills, mentored them and assured quality. The community-based health workers visited households to identify sick infants and referred them to the nearest BHU for further management. The research team collected data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 17\u00a0600 identified livebirths, 1860 young infants with any sign of PSBI sought care at BHUs and 1113 (59.8%) were brought by families. We achieved treatment coverage of 95%, assuming an estimated 10% incidence of PSBI in the first 2 months of life and that 10% of young infants came from outside the study catchment area. All 923 infants (49%; 923\/1860) 7\u201359\u00a0days old with only fast breathing (pneumonia) treated with outpatient oral amoxicillin were cured. Hospital referral was refused by 83.4% (781\/937) families who accepted outpatient treatment; 92.2% (720\/781) were cured and 0.8% (6\/781) died. Twelve (7.6%; 12\/156) died among those treated in a hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>It is feasible to achieve high coverage by implementing WHO PSBI management guidelines in a programmatic setting when a referral is not feasible.<\/jats:p><\/jats:sec>","DOI":"10.1093\/pubmed\/fdab409","type":"journal-article","created":{"date-parts":[[2021,12,30]],"date-time":"2021-12-30T12:20:25Z","timestamp":1640866825000},"page":"176-188","source":"Crossref","is-referenced-by-count":9,"title":["Implementation research to increase treatment coverage of possible serious bacterial infections in young infants when a referral is not feasible: lessons learnt"],"prefix":"10.1093","volume":"45","author":[{"given":"Shabina","family":"Ariff","sequence":"first","affiliation":[{"name":"Department of Paediatrics and Child Health , Aga Khan University, Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4192-8406","authenticated-orcid":false,"given":"Sajid Bashir","family":"Soofi","sequence":"additional","affiliation":[{"name":"Department of Paediatrics and Child Health , Aga Khan University, Karachi , Pakistan"},{"name":"Centre of Excellence in Women & Child Health , Aga Khan University, Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zamir","family":"Suhag","sequence":"additional","affiliation":[{"name":"People\u2019s Primary Healthcare Initiative , Sindh , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suhail","family":"Chanar","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women & Child Health , Aga Khan University, Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Bhura","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women & Child Health , Aga Khan University, Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zaib","family":"Dahar","sequence":"additional","affiliation":[{"name":"People\u2019s Primary Healthcare Initiative , Sindh , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imran","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women & Child Health , Aga Khan University, Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Turab","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women & Child Health , Aga Khan University, Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atif","family":"Habib","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women & Child Health , Aga Khan University, Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasir Bin","family":"Nisar","sequence":"additional","affiliation":[{"name":"Department of Maternal Newborn Child, Adolescent Health and Aging, World Health Organization , Geneva , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Aboubaker","sequence":"additional","affiliation":[{"name":"Department of Maternal Newborn Child, Adolescent Health and Aging, World Health Organization , Geneva , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Wall","sequence":"additional","affiliation":[{"name":"Saving Newborn Lives, Save the Children , Washington DC , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Wahab","family":"Soomro","sequence":"additional","affiliation":[{"name":"People\u2019s Primary Healthcare Initiative , Sindh , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamim Ahmad","family":"Qazi","sequence":"additional","affiliation":[{"name":"Former WHO Staff , Geneva , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajiv","family":"Bahl","sequence":"additional","affiliation":[{"name":"Department of Maternal Newborn Child, Adolescent Health and Aging, World Health Organization , Geneva , Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zulfiqar A","family":"Bhutta","sequence":"additional","affiliation":[{"name":"Centre of Excellence in Women & Child Health , Aga Khan University, Karachi , Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"issue":"10142","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/S0140-6736(18)31127-9","article-title":"Causes and incidence of community-acquired serious infections among young children in South Asia (ANISA): an observational cohort study","volume":"392","author":"Saha","year":"2018","journal-title":"The Lancet"},{"key":"2023031519072984700_","volume-title":"Levels & Trends In Child Mortality: Report 2019","author":"UN-IGME","year":"2020"},{"issue":"8","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/S1473-3099(14)70804-7","article-title":"Estimates of possible severe bacterial infection in neonates in sub-Saharan Africa, South Asia, and Latin America for 2012: a systematic review and meta-analysis","volume":"14","author":"Seale","year":"2014","journal-title":"Lancet Infect Dis"},{"key":"2023031519072984700_","volume-title":"Pocket book of hospital care for children: Guidelines for the management of common childhood illnesses","author":"World Health Organization","year":"2013"},{"issue":"9","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1038\/jp.2010.191","article-title":"Why do families of sick newborns accept hospital care? A community-based cohort study in Karachi, Pakistan","volume":"31","author":"Owais","year":"2011","journal-title":"J Perinatol"},{"issue":"2","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1093\/heapol\/16.2.193","article-title":"The effectiveness of patient referral in Pakistan","volume":"16","author":"Siddiqi","year":"2001","journal-title":"Health Policy Plan"},{"issue":"7","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1097\/INF.0b013e318256f86c","article-title":"Community-based treatment of serious bacterial infections in newborns and young infants: a randomized controlled trial assessing three antibiotic regimens","volume":"31","author":"Zaidi","year":"2012","journal-title":"Pediatr Infect Dis J"},{"key":"2023031519072984700_","volume-title":"Managing possible serious bacterial infection in young infants when referral is not feasible","author":"World Health Organization","year":"2015"},{"issue":"5","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"e279","DOI":"10.1016\/S2214-109X(14)70347-X","article-title":"Safety and efficacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open-label, equivalence trial","volume":"3","author":"Baqui","year":"2015","journal-title":"Lancet Glob Health"},{"issue":"9979","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"1758","DOI":"10.1016\/S0140-6736(14)62285-6","article-title":"Oral amoxicillin compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with fast breathing when referral is not possible: a randomised, open-label, equivalence trial","volume":"385","author":"Tshefu","year":"2015","journal-title":"The Lancet"},{"issue":"2","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"e177","DOI":"10.1016\/S2214-109X(16)30335-7","article-title":"Simplified antibiotic regimens for treatment of clinical severe infection in the outpatient setting when referral is not possible for young infants in Pakistan (simplified antibiotic therapy trial [SATT]): a randomised, open-label, equivalence trial","volume":"5","author":"Mir","year":"2017","journal-title":"Lancet Glob Health"},{"issue":"9979","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1016\/S0140-6736(14)62284-4","article-title":"Simplified antibiotic regimens compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with clinical signs of possible serious bacterial infection when referral is not possible: a randomised, open-label, equivalence trial","volume":"385","author":"Tshefu","year":"2015","journal-title":"The Lancet"},{"key":"2023031519072984700_","volume-title":"Provisional summary results of 6th population and housing census 2017","author":"Government of Pakistan","year":"2018"},{"key":"2023031519072984700_","volume-title":"Pakistan Demographic and Health Survey 2017-18","author":"National Institute of Population Studies (NIPS) [Pakistan], ICF International","year":"2019"},{"issue":"1","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1186\/1472-6963-10-319","article-title":"Evaluation of health workforce competence in maternal and neonatal issues in public health sector of Pakistan: an assessment of their training needs","volume":"10","author":"Ariff","year":"2010","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"2023031519072984700_","first-page":"170","article-title":"Healthcare system of Pakistan","volume":"1","author":"Hassan","year":"2017","journal-title":"IJARP"},{"issue":"1","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/1742-4755-10-60","article-title":"National program for family planning and primary health care Pakistan: a SWOT analysis","volume":"10","author":"Wazir","year":"2013","journal-title":"Reproductive health"},{"issue":"9884","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"2193","DOI":"10.1016\/S0140-6736(13)60019-7","article-title":"Pakistan's health system: performance and prospects after the 18th constitutional amendment","volume":"381","author":"Nishtar","year":"2013","journal-title":"The Lancet"},{"key":"2023031519072984700_","volume-title":"Operationalizing management of sick young infants with possible serious bacterial infection (PSBI) when referral is not feasible in the context of existing maternal, newborn, and child health programmes","author":"World Health Organization","year":"2017"},{"key":"2023031519072984700_","volume-title":"Integrated Management of Childhood Illness: management of the sick young infant aged up to 2 months. IMCI chart booklet","author":"World Health Organization, UNICEF","year":"2019"},{"issue":"4","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"e0229248","DOI":"10.1371\/journal.pone.0229248","article-title":"Feasibility of implementing the World Health Organization case management guideline for possible serious bacterial infection among young infants in Ntcheu district, Malawi","volume":"15","author":"Guenther","year":"2020","journal-title":"PLoS One"},{"issue":"6","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"e0234212","DOI":"10.1371\/journal.pone.0234212","article-title":"Identification and management of young infants with possible serious bacterial infection where referral was not feasible in rural Lucknow district of Uttar Pradesh, India: an implementation research","volume":"15","author":"Awasthi","year":"2020","journal-title":"PLoS One"},{"issue":"5","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"e0232675","DOI":"10.1371\/journal.pone.0232675","article-title":"Managing possible serious bacterial infection of young infants where referral is not possible: lessons from the early implementation experience in Kushtia District learning laboratory, Bangladesh","volume":"15","author":"Rahman","year":"2020","journal-title":"PLoS One"},{"issue":"2","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"e0244192","DOI":"10.1371\/journal.pone.0244192","article-title":"Innovative approach for potential scale-up to jump-start simplified management of sick young infants with possible serious bacterial infection when a referral is not feasible: findings from implementation research","volume":"16","author":"Leul","year":"2021","journal-title":"PLoS One"},{"issue":"3","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"e0228718","DOI":"10.1371\/journal.pone.0228718","article-title":"Implementation of the WHO guideline on treatment of young infants with signs of possible serious bacterial infection when hospital referral is not feasible in rural Zaria, Nigeria: challenges and solutions","volume":"15","author":"Wammanda","year":"2020","journal-title":"PLoS One"},{"issue":"4","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"e0231490","DOI":"10.1371\/journal.pone.0231490","article-title":"Caregiver acceptability of the guidelines for managing young infants with possible serious bacterial infections (PSBI) in primary care facilities in rural Bangladesh","volume":"15","author":"Applegate","year":"2020","journal-title":"PLoS One"},{"issue":"10","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"e0240688","DOI":"10.1371\/journal.pone.0240688","article-title":"Evaluating implementation of \u201cmanagement of possible serious bacterial infection (PSBI) when referral is not feasible\u201d in primary health care facilities in Sindh province, Pakistan","volume":"15","author":"Bhura","year":"2020","journal-title":"PLoS One"},{"issue":"2","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1136\/archdischild-2012-302033","article-title":"Community-acquired neonatal and infant sepsis in developing countries: efficacy of WHO's currently recommended antibiotics--systematic review and meta-analysis","volume":"98","author":"Downie","year":"2013","journal-title":"Arch Dis Child"},{"key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"k5314","DOI":"10.1136\/bmj.k5314","article-title":"Neonatal sepsis in South Asia: huge burden and spiralling antimicrobial resistance","volume":"364","author":"Chaurasia","year":"2019","journal-title":"BMJ"},{"issue":"1","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1136\/archdischild-2019-316816","article-title":"Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network","volume":"105","author":"Li","year":"2020","journal-title":"Arch Dis Child"},{"key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2019\/2489063","article-title":"Antibiotic use and resistance pattern in Ethiopia: systematic review and meta-analysis","volume":"2019","author":"Muhie","year":"2019","journal-title":"International Journal of Microbiology"},{"issue":"5","key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s00431-011-1592-5","article-title":"Social-economic factors and irrational antibiotic use as reasons for antibiotic resistance of bacteria causing common childhood infections in primary healthcare","volume":"171","author":"Ili\u0107","year":"2012","journal-title":"Eur J Pediatr"},{"key":"2023031519072984700_","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2013\/832857","article-title":"Trends of empiric antibiotic usage in a secondary care hospital, Karachi, Pakistan","volume":"2013","author":"Ali","year":"2013","journal-title":"Int J Pediatr"}],"container-title":["Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jpubhealth\/article-pdf\/45\/1\/176\/49527254\/fdab409.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jpubhealth\/article-pdf\/45\/1\/176\/49527254\/fdab409.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,15]],"date-time":"2023-11-15T00:32:20Z","timestamp":1700008340000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jpubhealth\/article\/45\/1\/176\/6524747"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":33,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,2,9]]},"published-print":{"date-parts":[[2023,3,14]]}},"URL":"https:\/\/doi.org\/10.1093\/pubmed\/fdab409","relation":{},"ISSN":["1741-3842","1741-3850"],"issn-type":[{"value":"1741-3842","type":"print"},{"value":"1741-3850","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,3]]},"published":{"date-parts":[[2022,2,9]]}}}