Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: Coverage and compliance with referral

Gary L. Darmstadt, Shams El Arifeen, Yoonjoung Choi, Sanwarul Bari, Syed M. Rahman, Ishtiaq Mannan, Peter J. Winch, Asm Nawshad Uddin Ahmed, Habibur Rahman Seraji, Nazma Begum, Robert E. Black, Mathuram Santosham, Abdullah H. Baqui

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


Background Effective and scalable community-based strategies are needed for identification and management of serious neonatal illness.Methods As part of a community-based, cluster-randomized controlled trial of the impact of a package of maternal-neonatal health care, community health workers (CHWs) were trained to conduct household surveillance and to identify and refer sick newborns according to a clinical algorithm. Assessments of newborns by CHWs at home were linked to hospital-based assessments by physicians, and factors impacting referral, referral compliance and outcome were evaluated.Results Seventy-three per cent (7310/10 006) of live-born neonates enrolled in the study were assessed by CHWs at least once; 54 were assessed within 2 days of birth, but only 15 were attended at delivery. Among assessments for which referral was recommended, compliance was verified in 54 (495/919). Referrals recommended to young neonates 0-6 days old were 30 less likely to be complied with compared to older neonates. Compliance was positively associated with having very severe disease and selected clinical signs, including respiratory rate ≥70/minute; weak, abnormal or absent cry; lethargic or less than normal movement; and feeding problem. Among 239 neonates who died, only 38 were assessed by a CHW before death.Conclusions Despite rigorous programmatic effort, reaching neonates within the first 2 days after birth remained a challenge, and parental compliance with referral recommendation was limited, particularly among young neonates. To optimize potential impact, community postnatal surveillance must be coupled with skilled attendance at delivery, and/or a worker skilled in recognition of neonatal illness must be placed in close proximity to the community to allow for rapid case management to avert early deaths.

Original languageEnglish (US)
Pages (from-to)112-124
Number of pages13
JournalHealth policy and planning
Issue number2
StatePublished - Mar 2010


  • Care seeking
  • Community health worker
  • Neonatal illness
  • Referral
  • Surveillance

ASJC Scopus subject areas

  • Health Policy


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