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Implementation of the ANISA Protocol in Sylhet, Bangladesh: Challenges and Solutions
Dipak K Mitra1, Arif Mahmud, Nazma Begum
1From the *Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; †Child Health Research Foundation, Dhaka, Bangladesh; and ‡Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
Insights
Implementing the Aetiology of Neonatal Infection in South Asia (ANISA) study in Sylhet faced challenges like timely postnatal visits. Strategies such as community mobilization and cellphone notifications ensured successful study implementation.
Area of Science:
- Global Health
- Infectious Diseases
- Neonatal Care
Background:
- Limited data exists on bacterial and viral causes of infections in young infants (0-59 days) in resource-poor settings.
- Understanding these etiologies is crucial for developing effective preventive strategies and antibiotic treatments to reduce infant mortality.
- The Aetiology of Neonatal Infection in South Asia (ANISA) study aims to generate this vital data in Bangladesh, India, and Pakistan.
Purpose of the Study:
- To describe the contextual challenges encountered during the implementation of the ANISA study in Sylhet, Bangladesh.
- To outline the strategies developed and employed by the research team to overcome these implementation challenges.
- To ensure the successful execution of the ANISA study protocol while maintaining high-quality standards.
Main Methods:
- The ANISA study protocol implementation in Sylhet.
- Addressing challenges related to early postnatal visits (within 24 hours of birth).
- Utilizing community mobilization, cellphone-based birth notifications, quality hospital services, and referral support.
Main Results:
- Key challenges included home births, low referral compliance for newborn illness, and high blood culture contamination rates.
- Strategies implemented successfully facilitated adherence to the study protocol.
- High-quality specimen collection, transportation, and processing were maintained.
Conclusions:
- The research team successfully navigated implementation challenges in Sylhet.
- The ANISA study is being effectively implemented, adhering to high-quality benchmarks.
- The study will provide critical data on neonatal infections in South Asia.
Background:
Despite the high rate of deaths in young infants (0-59 days) attributable to infections in resource-poor countries, data on bacterial and viral etiologies of community-acquired infections in this age group are limited. These data are needed to develop appropriate preventive strategies and suitable antibiotic treatment regimens for reducing the number of young infant deaths from infections. The Aetiology of Neonatal Infection in South Asia (ANISA) study is designed to generate these critical data and is being implemented in Bangladesh, India and Pakistan. The Sylhet site in Bangladesh was selected because neonatal mortality is high in this country and particularly in Sylhet District. In this article, we describe the contextual challenges in implementing the ANISA study in Sylhet, as well as the strategies developed by our team to address these challenges.
Contextual Challenges:
The major challenge in implementing the ANISA protocol in Sylhet is conducting the first postnatal visit within 24 hours of birth. This problem stems from several social, cultural and geographical characteristics of the study population and its demographic profile. In this area, most births take place at home, referral compliance for newborn illness to health facilities is low and the blood culture contamination rate is high. Community mobilization, cellphone-based birth notification by families, delivery of quality services at study hospitals and referral support to families in need were some of the strategies adopted by the Sylhet site team for overcoming these challenges during study implementation. Quality control in specimen collection, transportation and processing also plays a role in ensuring satisfactory performance.
Conclusion:
Our research team, with support from the ANISA coordination center, has successfully addressed these challenges and is implementing the study protocol while maintaining the high quality benchmark set by the coordination center.
