title: Implementation of the ANISA Protocol in Sylhet, Bangladesh: Challenges and Solutions.
abstract: BACKGROUND
  Despite the high rate of deaths in young infants (0-59 days) attributable to infections in resource-poor countries, data on bacterial and viral etiologies of community-acquired infections in this age group are limited. These data are needed to develop appropriate preventive strategies and suitable antibiotic treatment regimens for reducing the number of young infant deaths from infections. The Aetiology of Neonatal Infection in South Asia (ANISA) study is designed to generate these critical data and is being implemented in Bangladesh, India and Pakistan. The Sylhet site in Bangladesh was selected because neonatal mortality is high in this country and particularly in Sylhet District. In this article, we describe the contextual challenges in implementing the ANISA study in Sylhet, as well as the strategies developed by our team to address these challenges.
  The major challenge in implementing the ANISA protocol in Sylhet is conducting the first postnatal visit within 24 hours of birth. This problem stems from several social, cultural and geographical characteristics of the study population and its demographic profile. In this area, most births take place at home, referral compliance for newborn illness to health facilities is low and the blood culture contamination rate is high. Community mobilization, cellphone-based birth notification by families, delivery of quality services at study hospitals and referral support to families in need were some of the strategies adopted by the Sylhet site team for overcoming these challenges during study implementation. Quality control in specimen collection, transportation and processing also plays a role in ensuring satisfactory performance.
  
  
  CONCLUSIONS
  Our research team, with support from the ANISA coordination center, has successfully addressed these challenges and is implementing the study protocol while maintaining the high quality benchmark set by the coordination center.
authors.affiliation: From the *Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; †Child Health Research Foundation, Dhaka, Bangladesh; and ‡Centre for Reproductive Health, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
authors.forename: Dipak K
authors.initials: DK
authors.lastname: Mitra
authors.forename: Arif
authors.initials: A
authors.lastname: Mahmud
authors.forename: Nazma
authors.initials: N
authors.lastname: Begum
authors.forename: Iftekhar
authors.initials: I
authors.lastname: Rafiqullah
authors.forename: Arunangshu
authors.initials: A
authors.lastname: Roy
authors.forename: Syed Mamun Ibne
authors.initials: SM
authors.lastname: Moin
authors.forename: Maksuda
authors.initials: M
authors.lastname: Islam
authors.forename: Md Abdul
authors.initials: MA
authors.lastname: Quaiyum
authors.forename: Jannatul
authors.initials: J
authors.lastname: Ferdous
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Applegate
authors.forename: Samir K
authors.initials: SK
authors.lastname: Saha
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D003625:Data Collection; D062665:Epidemiological Monitoring; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D000071074:Neonatal Sepsis / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D013048:Specimen Handling