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Table 1 Operational algorithm for managing infections in young infants in UH&FWC per the Bangladesh guidelines

From: Implementation research to support Bangladesh Ministry of Health and Family Welfare to implement its national guidelines for management of infections in young infants in two rural districts

CategoryClinical signsManagementFollow-up and referral support
Critical illnesses (CI)• Unconscious/drowsy
• Convulsion/history of convulsion
• Unable to feed
• Persistent vomiting
• Central cyanosis
• Bulging fontanel
• Weight < 1500 g
• The young infant will be administered the 1st dose of injectable gentamicin and oral antibiotic (if possible), advised about the importance of hospitalization and referred urgently to the designated referral facility with a referral slip containing referral notes of SACMO
• The mother will be advised on frequent breastfeeding to prevent low blood sugar. She will also be properly advised to keep the baby warm especially during transportation.
• The mobile phone contact number will be kept to follow-up the referral compliance. The phone number of the SACMO will be provided to the family
• The UH&FWC service providers will communicate with the Upazila Health Complex (UHC) (referral center) about the case
• Necessary support to be provided by UH&FWC service providers or field supervisors to arrange transport for referral
Clinical severe infection (CSI)*• Severe chest in-drawing
• Hypothermia (< 95.9 °F or 35.5 °C
• Raised temperature (> 99.5 °F or 37.5 °C)
• Less movement/movement only when stimulated
• Not feeding well (depending on history and observation)
• The case will be administered 1st dose injectable gentamicin and oral amoxicillin, and referred following the above procedure to the nearest UHC for management• Same as above, the SACMO’s mobile number will be given to caregiver and the case will be followed up over phone to record referral compliance on the day of referral by UH&FWC provider
In case of referral non-compliance:
• The infant will be managed by the SACMO using standard management protocol:
 o Injection gentamicin I/M once daily at UH&FWC for 2 days
 o Oral amoxicillin twice daily for 7 days
 • The family will be counseled and advised to come to the same facility with the baby to receive the 2nd (last) dose of injectable antibiotic and continue oral medicine 12 hourly for total 7 days
• On the 2nd day of treatment, the infant should return to UH&FWC for assessment and 2nd dose injectable gentamicin
• On the 4th and 8th day of treatment, follow-up will be conducted to assess condition of the infant
• If the baby develops any new symptom (listed symptoms of CSI or CI),
does not improve after 4 days of receiving treatment or,
is not fully cured after treatment completion (on the 8th day); the family should be advised for immediate notification to the same service provider and to seek care from referral facility
Isolated fast-breathing as single sign of illness• Young infants 0–6 days old with fast breathing as the only sign of illness*• Give 1st dose of oral amoxicillin and refer to UHC• The mobile phone contact number will be kept to follow-up the referral compliance. The phone number of the SACMO will be provided to the family
• The UH&FWC service providers will communicate with the UHC (referral center) about the case
In case of referral non-compliance:
• The infant will be managed by the SACMO using standard management protocol:
 o Oral amoxicillin (100 mg/kg/day twice daily) for 7 days
• Infant will be followed up on the 4th day and 8th day
• If the baby develops any new symptom (listed symptoms of CSI or CI) or, does not improve after 4 days of receiving treatment, or is not fully cured after treatment completion (on 8th day), the family should be advised for immediate notification to the same service provider and to seek care from referral facility
• Young infants 7–59 days old with fast breathing as the only sign of illness• No referral, treated with oral amoxicillin (100 mg/kg/day twice daily) for 7 days• Sick infants with fast-breathing (7–59 days) will be followed up on the 4th day and 8th day
Local bacterial infection• Umbilical redness
• Draining pus from umbilicus
• Skin pustule
• No referral, treated with oral amoxicillin (125 mg daily for below 1-month aged infants or infants having less than 4 kg weight and 250 mg for infants aged between 1 and 2 months) for 5 days• Caregiver will be advised to seek immediate consultation with UH&FWC provider if infant does not improve, new symptoms appear, or condition worsens
  1. *PSBI cases eligible for simplified antibiotic treatment when hospital referral is not feasible for families