Design-Stage Trial of Gentamicin in the Uniject Device

FGD participants also noted that the presence of supervisors during administration of gentamicin inUniject appeared to enhance the level of trust among community members. Only one participantstated that these supervisory visits were stressful:“The presence of the supervisor gave me confidence to give injection. Butat the same time, I was afraid that I might do something wrong in front ofthe supervisor.” Govindapur VDCParticipants in four of the five FGDs agreed that, in the future, supervisors should come at leastonce during the course of treatment, preferably on the first or second day. Participants in one FGDhad an alternative viewpoint, stating that day 3 of treatment would be the best time for a supervisoryvisit. Participants in this FGD explained that:“If the supervisors can go on the third day in which we do the follow-upand reassessment of the sick newborn, then this will be good. They canadvise us after reassessing the sick newborn.” Madhumalla VDC4.6 Service provisionPerception of burden by FCHVsOn average, FCHVs spent 8 hours per week on Uniject activities. Among the 33 FCHVs whotreated PSBI cases with gentamicin in Uniject, 31 did not perceive giving gentamicin in Uniject asan extra burden, while 2 FCHVs reported this activity as an extra burden to them. In the FGDs, theFCHVs identified several challenges in their work to treat sick newborns (Table 15).Table 15. Challenges faced by FCHVs.Traveling to the home of the infant to treat for 7consecutive days is a burden both in terms of timeand distance.Concern about their liability if the baby they aretreating dies.Concern that community members think they arereceiving payment for their services.“It takes 2-3 hours to go for treatment. So we have toadjust the time from family work.” Sorabhag VDC“I was worried because if something goes wrong,then what the community will say?” Hatimuda VDC“Volunteerism is a challenge; people do not trustthat we work for free.” Madhumalla VDCHealth-seeking behavior by caretakers of sick infantsAmong the 45 caretakers interviewed, 37 (82%) knew about provision of treatment with gentamicinin Uniject by the FCHVs in their communities. All caretakers knew at least one of the ten dangersigns of PSBI, yet only two caretakers (4%) knew at least five signs.Twenty-four percent of caretakers knew that the baby should be dried thoroughly after delivery,and 24% of them had practiced it after their last delivery. Similarly, 89% knew to dry and keep thebaby warm and 91% of them had done so. Forty-two percent of caretakers had the knowledge andpracticed delaying bathing for 24 hours. A total of 69% of caretakers understood that nothingshould be applied to the umbilical cord, but more caretakers (89%) had actually practiced this.Fifty-one percent of caretakers knew the baby should be breastfed within one hour of birth, yetFinal Report(36) Gentamicin in Uniject: A Feasibility Study