{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T15:41:42Z","timestamp":1785426102155,"version":"3.56.0"},"reference-count":33,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T00:00:00Z","timestamp":1664150400000},"content-version":"unspecified","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2022,9,1]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Although hospitalisation remains the preferred management for neonatal sepsis, it is often not possible in resource-limited settings. The Home-Based Newborn Care (HBNC) study in Gadchiroli, India (1995\u20131998) was the first trial to demonstrate that neonatal sepsis can be managed in the community. HBNC continues to operate in Gadchiroli. In 2015, WHO recommended community-based management of neonatal sepsis when hospitalisation is not feasible but called for implementation research. We studied the implementation and effectiveness of home-based management of neonatal sepsis over 23 years in Gadchiroli.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this cohort study (1996\u20132019), community health workers (CHWs) visited neonates at home in 39 villages in Gadchiroli, India. CHWs screened, diagnosed sepsis and offered home-based antibiotic treatment if hospitalisation was refused. We evaluated the implementation outcomes of coverage, diagnostic fidelity and adoption. We assessed the association between treatment type and odds of neonatal death using mixed effects logistic regression. Time trends were analysed using the Mann-Kendall test.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>CHWs screened 93.8% (17 700\/18 874) of neonates (coverage) and correctly diagnosed 89% (1051\/1177) of sepsis episodes (diagnostic fidelity). Home-based management was preferred by 88.4% (929\/1051) of parents (adoption), with 5.6 percent of total neonates receiving antibioties at home. Compared with neonates treated at home, the adjusted odds of death was 5.27 (95% CI 1.91 to 14.58) times higher when parents refused all treatment, 2.17 (95% CI 1.07 to 4.41) times higher when CHWs missed the diagnosis and 5.45 (95% CI 2.74 to 10.87) times higher when parents accepted hospital referral. Implementation outcomes remained consistent over 23 years (coverage p=0.57; fidelity p=0.57; adoption p=0.26; mortality p=0.71). The rate of facility births increased (p&lt;0.01) and the sepsis incidence decreased (p&lt;0.05) over 23 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Implementation of home-based management of neonatal sepsis was sustainable and effective over 23 years. During this period, the need for home-based management in Gadchiroli is declining. Home-based management is advised where sepsis remains a major cause of neonatal mortality and hospital access is limited.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjgh-2022-008469","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T12:32:48Z","timestamp":1664195568000},"page":"e008469","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Home-based management of neonatal sepsis: 23 years of sustained implementation and effectiveness in rural Gadchiroli, India, 1996\u20132019"],"prefix":"10.1136","volume":"7","author":[{"given":"Abhay","family":"Bang","sequence":"first","affiliation":[{"name":"Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Baitule","sequence":"additional","affiliation":[{"name":"Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahesh","family":"Deshmukh","sequence":"additional","affiliation":[{"name":"Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anand","family":"Bang","sequence":"additional","affiliation":[{"name":"Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Duby","sequence":"additional","affiliation":[{"name":"McGill University Health Centre, Montreal, Qu\u00e9bec, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,26]]},"reference":[{"key":"2025072915115274000_7.9.e008469.1","unstructured":"World Health Organization . WHO-MCEE methods and data sources for child causes of death 2000-2017. Geneva, Switzerland: World Health Organization, 2018."},{"key":"2025072915115274000_7.9.e008469.2","unstructured":"World Health Organization . Pocket book of hospital care for children. 2nd edn. Geneva, Switzerland: World Health Organization, 2013."},{"key":"2025072915115274000_7.9.e008469.3","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2010.191"},{"key":"2025072915115274000_7.9.e008469.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)03046-9"},{"key":"2025072915115274000_7.9.e008469.5","doi-asserted-by":"publisher","DOI":"10.1097\/01.inf.0000157094.43609.17"},{"key":"2025072915115274000_7.9.e008469.6","doi-asserted-by":"crossref","first-page":"S62","DOI":"10.1038\/sj.jp.7211273","article-title":"Is home-based diagnosis and treatment of neonatal sepsis feasible and effective? seven years of intervention in the Gadchiroli field trial (1996 to 2003)","volume":"25 Suppl 1","author":"Bang","year":"2005","journal-title":"J Perinatol"},{"key":"2025072915115274000_7.9.e008469.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60835-1"},{"key":"2025072915115274000_7.9.e008469.8","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"},{"key":"2025072915115274000_7.9.e008469.9","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"},{"key":"2025072915115274000_7.9.e008469.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)62284-4"},{"key":"2025072915115274000_7.9.e008469.11","unstructured":"World Health Organization . Managing possible serious bacterial infection in young infants when referral is not feasible. Geneva, Switzerland: World Health Organization, 2015."},{"key":"2025072915115274000_7.9.e008469.12","doi-asserted-by":"crossref","first-page":"S11","DOI":"10.1038\/sj.jp.7211268","article-title":"Methods and the baseline situation in the field trial of home-based neonatal care in Gadchiroli, India","volume":"25 Suppl 1","author":"Bang","year":"2005","journal-title":"J Perinatol"},{"key":"2025072915115274000_7.9.e008469.13","doi-asserted-by":"crossref","first-page":"S3","DOI":"10.1038\/sj.jp.7211267","article-title":"Background of the field trial of home-based neonatal care in Gadchiroli, India","volume":"25 Suppl 1","author":"Bang","year":"2005","journal-title":"J Perinatol"},{"key":"2025072915115274000_7.9.e008469.14","doi-asserted-by":"publisher","DOI":"10.1177\/1077558711430690"},{"key":"2025072915115274000_7.9.e008469.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.f6753"},{"key":"2025072915115274000_7.9.e008469.16","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s13012-017-0637-1","article-title":"Developing a comprehensive definition of sustainability","volume":"12","author":"Moore","year":"2017","journal-title":"Implement Sci"},{"key":"2025072915115274000_7.9.e008469.17","doi-asserted-by":"crossref","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"},{"key":"2025072915115274000_7.9.e008469.18","doi-asserted-by":"crossref","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"},{"key":"2025072915115274000_7.9.e008469.19","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0240688","article-title":"Evaluating implementation of \"management of Possible Serious Bacterial Infection (PSBI) when referral is not feasible\" in primary health care facilities in Sindh province, Pakistan","volume":"15","author":"Bhura","year":"2020","journal-title":"PLoS One"},{"key":"2025072915115274000_7.9.e008469.20","doi-asserted-by":"publisher","DOI":"10.9745\/GHSP-D-16-00312"},{"key":"2025072915115274000_7.9.e008469.21","doi-asserted-by":"crossref","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"},{"key":"2025072915115274000_7.9.e008469.22","doi-asserted-by":"crossref","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"},{"key":"2025072915115274000_7.9.e008469.23","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0252700","article-title":"Lessons from implementation research on community management of possible serious bacterial infection (psbI) in young infants (0-59 days), when the referral is not feasible in Palwal district of Haryana, India","volume":"16","author":"Mukhopadhyay","year":"2021","journal-title":"PLoS One"},{"key":"2025072915115274000_7.9.e008469.24","doi-asserted-by":"crossref","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"},{"key":"2025072915115274000_7.9.e008469.25","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0236355","article-title":"Feasibility of implementation of simplified management of young infants with possible serious bacterial infection when referral is not feasible in tribal areas of Pune district, Maharashtra, India","volume":"15","author":"Roy","year":"2020","journal-title":"PLoS One"},{"key":"2025072915115274000_7.9.e008469.26","doi-asserted-by":"crossref","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"},{"key":"2025072915115274000_7.9.e008469.27","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181958780"},{"key":"2025072915115274000_7.9.e008469.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2011.12.023"},{"key":"2025072915115274000_7.9.e008469.29","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2017-000680","article-title":"Effect of home-based newborn care on neonatal and infant mortality: a cluster randomised trial in India","volume":"5","author":"Rasaily","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2025072915115274000_7.9.e008469.30","unstructured":"Ministry of Health & Family Welfare . Home based newborn care operational guidelines. New Delhi, India: Government of India, 2011."},{"key":"2025072915115274000_7.9.e008469.31","unstructured":"Bang AT , Paranjpe P , Baitule S . How to train ASHAs in HBNCC: training manual.Gadchiroli. India: SEARCH, 2010."},{"key":"2025072915115274000_7.9.e008469.32","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1097\/INF.0000000000003248","article-title":"Decline in the incidence of neonatal sepsis in rural Gadchiroli, India during the twenty-one years (1998-2019) following the home-based neonatal care field trial","volume":"40","author":"Bang","year":"2021","journal-title":"Pediatr Infect Dis J"},{"key":"2025072915115274000_7.9.e008469.33","first-page":"952","article-title":"Burden of morbidities and the unmet need for health care in rural neonates--a prospective observational study in Gadchiroli, India","volume":"38","author":"Bang","year":"2001","journal-title":"Indian Pediatr"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2022-008469","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T22:12:02Z","timestamp":1753827122000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2022-008469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,26]]},"published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1136\/bmjgh-2022-008469"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2022-008469","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9]]}}}