Design-Stage Trial of Gentamicin in the Uniject Device

When a family informs an FCHV of a birth, she immediately goes to the baby’s home and weighsthe newborn using a color-coded Salter scale. This scale has three different categories of weight:red (less than 2000 grams), yellow (2000–2499 grams), and green (2500 grams or more). Forbabies who are in the “green” or “normal” weight category, the FCHV gives advice about ENC;for babies in the “yellow” or “low birth weight” category, she advises on ENC, with extra emphasison keeping the baby warm, including skin-to-skin contact and frequent breastfeeding; and for babiesin the “red” or “very low birth weight” group, she recommends that they go immediately to thenearest health facility for further advice and counseling. However, families may not be able tocomply with the FCHV referral advice. In such cases, she treats the newborns as low birth weightbabies. For all babies in the “red” and “yellow” categories, the FCHV makes four follow-up visits,once per week within the first month of life to reassess the babies and support the families inproviding care. She prepares a birth record and leaves one copy with the family to help facilitateformal registration of the birth with the VDC officials. She revisits all newborns at 2 months of ageto document their status (dead/alive). See Figure 2 for activities conducted by FCHVs with allpregnant women and newborns.Figure 2. MINI activities for all babies.Early antenatal household contact by FCHVFCHV informed of birth by familyFCHV postpartum visit within 3 days toassess and weigh baby, counsel, issue birth recordVery low birth weightLow birth weightNormal birth weightReferredWeekly follow-upvisits (four times)Status follow-up at 2 months2.2 Identification and treatment of PSBI by FCHVsFor all newborns, regardless of weight, FCHVs conduct an initial clinical assessment, using analgorithm to identify any danger signs, as shown in Figure 3. The algorithm is depicted on a laminatedclassification card, carried in a shoulder bag along with other program materials. The tendanger signs are shown pictorially, as many FCHVs and mothers have limited literacy skills.The FCHV uses a timer to count respiratory rate and a flat, mercury thermometer to assesstemperature. If she finds any danger signs, she classifies the newborn as having PSBI and initiatestreatment immediately. If no danger signs are identified, she advises the family to call her backimmediately if any sign develops in the future.Final Report(6) Gentamicin in Uniject: A Feasibility Study