Design-Stage Trial of Gentamicin in the Uniject Device

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egisters. Resupply was done by the health facilities as needed. At the end of the study period,research staff collected unused devices and disposed of them safely.After training the FCHVs on the use of gentamicin in Uniject, a meeting was held at the villagelevel (one per FCHV), where the FCHV was supported by health facility and DPHO/MINI programstaff to inform her fellow villagers about her new training. She informed them that she could nowtreat sick newborns with cotrimoxazole-p and gentamicin in Uniject. VDC- and district-levelorientations were also conducted before the introduction of the program, to inform village and localcommunity leaders.A post-training questionnaire was administered to all participants to evaluate the effectiveness ofthe training curriculum. For illiterate FCHVs, a trainer would read the questions aloud to the individualFCHV and then record her verbal responses on the questionnaire. A competency certification testwas also performed for all health workers by one of the trainers. Only those FCHVs who passedthis certification were provided with gentamicin in Uniject to take home.3.6 Training materialsMost of the materials developed for the MINI program were adapted for this new intervention. Allchanges were minimized in order to reduce the recording and reporting burden for FCHVs. Thefollowing training materials were used specifically for this gentamicin in Uniject design-stage trial.Training module. The training module used in the MINI intervention was revised to incorporatenew technical content for the study. Two separate modules, “Community-based management ofsick young infants with cotrimoxazole-p and gentamicin in Uniject for Health Workers” and“Community-based management of sick young infants with cotrimoxazole-p and gentamicin inUniject for FCHVs” were developed.Flex chart. Flex charts (flexible wall charts that can be writtenon and then cleaned for reuse) were developed to model treatmentregisters used in the study. The charts were used during trainingto practice recording and reporting.Figure 14. Salterweighing scale.Danglers. Danglers (job aids that can be suspended) that showedpictures of newborns with different danger signs were used topractice recognition of newborn danger signs and classificationof illness by FCHVs.Classification card. A pictorial classification card in a simplebooklet form was developed for the FCHVs. The four-pageclassification card was used as a job aid to assess and classifyillness in newborns and young infants (Appendix A). The firstpage of this colored card described the program by title andshowed the scale and treatments being used. The second pagecontained the ten danger signs of PSBI, the signs of local bacterialFinal Report(20) Gentamicin in Uniject: A Feasibility Study
infections, and ENC messages. The third page contained the color-coded weighing scale, whichwas linked with the dosing regimen for the gentamicin in Uniject as well as the dosing regimen forcotrimoxazole-p tablets. The last page contained information about the steps to be followed to givegentamicin in Uniject correctly, including advice on correct disposal. The FCHVs used this card asa job aid while they were assessing and treating the newborns and young infants.Weighing scale. The color-coded Salter scale (Figure 14) was used for weighing newborns. Thevery low birth weight part of the scale was colored red, the low birth weight category was coloredyellow, and the normal weight category was colored green. Also, a white mark on the Salter scaleindicated a weight of 3500 grams. Any sick newborns that weighed more than 3500 grams werereferred to the health facility, as they required a higher dose of gentamicin than those available inthe Uniject devices.Figure 15. Thermometer with cutoff points.Thermometer. FCHVs were provided witha flat mercury thermometer with two separatemarks to indicate the cutoffs for hypothermiaand fever (Figure 15).Colored laboratory coats. Three colored laboratory coats (red, yellow, and green) were used topractice assessment of danger signs. The danglers with different danger signs were provided to theFCHVs during training, and they had to decide how to classify the sign and then place the dangleron the person wearing the correct colored laboratory coat (Figure 16).Safe-disposal box. A small disposal box was designed for the safe disposal of the used Unijectdevices, as shown in Figure 11. One box was used to dispose of the used Uniject devices from thetreatment of one sick child.Eggplant. An eggplant was used during training to practice the skills for injection (Figure 17).Water-filled Uniject devices. Water-filled Uniject devices were used during training to masterthe skill of giving gentamicin in Uniject.Dolls. Pieces of iron of three different weights(2.5 kg) were inserted into theclothing of dolls. The dolls were used by FCHVsto practice the weighing skill during training.Figure 16. Practice of assessment ofdanger signs with colored laboratory coats.Birth record form. A simple pictorial form(Appendix B) from the MINI program was usedto record information at the time of birth. FCHVsused this form during the early postnatal visit.One part of the form was given to the family forofficial birth registration at the VDC, and theFCHV retained the other piece of the form forher records. The FCHVs recorded the status ofnewborns at the age of 2 months on the sameGentamicin in Uniject: A Feasibility Study(21)Final Report
Page 1: Design-Stage Trial of Gentamicinin
Page 4 and 5: Study investigatorsDr. Y. V. Pradha
Page 7 and 8: Table of contentsAcknowledgmentsiii
Page 9 and 10: Figure 13. District Public Health A
Page 11 and 12: Executive SummaryThis design-stage
Page 13 and 14: Data were collected during the inte
Page 15 and 16: 1. Introduction and rationaleEvery
Page 17 and 18: 2. Background2.1 Community-based ma
Page 19 and 20: ners for improving newborn health a
Page 21 and 22: When the FCHV assesses a youngFigur
Page 23 and 24: These studies occurred with the col
Page 25 and 26: with suspected sepsis in the neonat
Page 27 and 28: 3. Study methods3.1 Description of
Page 29 and 30: The following research objectives w
Page 31 and 32: health facility, where they receive
Page 33: community level. The trainings were
Page 37 and 38: Table 4. Data collection instrument
Page 39 and 40: 4. ResultsData were collected durin
Page 41 and 42: Figure 19. Knowledge on device perf
Page 43 and 44: Figure 22. Knowledge of the Uniject
Page 45 and 46: VHWs/MCHWs. Among them were 3 very
Page 47 and 48: color-coded weight category, and th
Page 49 and 50: During their supervision, none of t
Page 51 and 52: 56% of them were able to breastfeed
Page 53 and 54: for sick young infants by FCHVs at
Page 55 and 56: 5. DiscussionThe gentamicin in Unij
Page 57 and 58: phones to contact their supervisors
Page 59 and 60: 6. Limitations of the studyAll stud
Page 61 and 62: 14. Bahamondes L, Marchi NM, de Lou
Page 63 and 64: 2007Possible Severe Bacterial Infec
Page 65 and 66: Steps for Injection:1 2Wash your ha
Page 67 and 68: Appendix CGovernment of NepalMinist
Page 69 and 70: Government of NepalMinistry of Heal
Page 71 and 72: Consent from guardian Yes NoWeight
Page 73 and 74: Appendix EPreparing for trainingDPH

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