Challenges in Implementation of the ANISA Protocol at the Matiari Site, Pakistan
- 1 May 2016
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in The Pediatric Infectious Disease Journal
- Vol. 35 (5), S65-S69
- https://doi.org/10.1097/inf.0000000000001110
Abstract
Background: The Aetiology of Neonatal Infection in South Asia (ANISA) study is a population-based study with sites in Bangladesh, India and Pakistan. It aims to determine community-acquired incidence, etiology and associated risk factors for neonatal infections. Matiari, a rural site in Pakistan, was chosen for the study due to its high neonatal mortality rate and the presence of an established pregnancy and birth surveillance system. This article summarizes various challenges, remedial measures taken and lessons learned during the implementation of the ANISA study protocol in the unique rural setting of Matiari where the majority of births take place at home and accessibility to health care is limited. Challenges: Achieving and maintaining project targets of early registration of birth and collection of biological specimens in households have been challenging in Matiari. Capturing births of study subjects that occur outside the catchment areas and those taking place during public holidays and acquiring parental consent for specimen collection from healthy controls require extensive community mobilization. Contamination and power outages that affect the laboratory equipment are 2 of the major logistic challenges faced. We keep track of pregnancy outcomes through mobile phones and reimburse the costs for birth notifications to the caller. We created separate dedicated mobile teams that visit newborns outside the catchment area and carry out possible serious bacterial infection assessments. We also formed mobile teams for specimen collection from residences of newborns as there is no facility for specimen collection at this site. Our study personnel work on holidays and weekends to improve the study's performance. We nurture strong community liaison by employing staff from within the community. We train the study physicians on communication and counseling skills required for overcoming refusal for referral and specimen collection. The contamination rate is controlled by repeated training and supervision and extensive monitoring of phlebotomy activities. The majority of phlebotomy procedures are recorded on video in the field to provide feedback to phlebotomists for improving their performance. Conclusion: The contextual challenges faced in field implementation of the ANISA protocol in the rural setting of Matiari are unique. These challenges are being successfully addressed through hard work, strict monitoring and improvisation. This experience can be used for improving study performance in similar settings elsewhere.Keywords
This publication has 8 references indexed in Scilit:
- Infection Surveillance Protocol for a Multicountry Population-based Study in South Asia to Determine the Incidence, Etiology and Risk Factors for Infections Among Young Infants of 0 to 59 Days OldThe Pediatric Infectious Disease Journal, 2016
- Using Text Messages for Critical Real-time Data Capture in the ANISA StudyThe Pediatric Infectious Disease Journal, 2016
- Laboratory Methods for Determining Etiology of Neonatal Infection at Population-based Sites in South AsiaThe Pediatric Infectious Disease Journal, 2016
- Methods Employed in Monitoring and Evaluating Field and Laboratory Systems in the ANISA StudyThe Pediatric Infectious Disease Journal, 2016
- Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: a cluster-randomised trialThe Lancet, 2013
- Effectiveness of community case management of severe pneumonia with oral amoxicillin in children aged 2–59 months in Matiari district, rural Pakistan: a cluster-randomised controlled trialThe Lancet, 2012
- Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster-randomised effectiveness trialThe Lancet, 2011
- Implementing community-based perinatal care: results from a pilot study in rural PakistanBulletin of the World Health Organization, 2008