No abstract

Poor care seeking contributes significantly to high neonatal mortality in developing countries. The study was conducted to identify care-seeking patterns for sick newborns in rural Rajasthan, India, and to understand family perceptions and circumstances that explain these patterns. Of the 290 mothers interviewed when the infant was 1 to 2 months of age, 202 (70%) reported at least one medical condition during the neonatal period that would have required medical care, and 106 (37%) reported a danger sign during the illness. However, only 63 (31%) newborns with any reported illness were taken to consult a care provider outside home, about half of these to an unqualified modern or traditional care provider. In response to hypothetical situations of neonatal illness, families preferred home treatment as the first course of action for almost all conditions, followed by modern treatment if the child did not get better. For babies born small and before time, however, the majority of families does not seem to have any preference for seeking modern treatment even as a secondary course of action. Perceptions of 'smallness', not appreciating the conditions as severe, ascribing the conditions to the goddess or to evil eye, and fatalism regarding surviving newborn period were the major reasons for the families' decision to seek care. Mothers were often not involved in taking this critical decision, especially first-time mothers. Decision to seek care outside home almost always involved the fathers or another male member. Primary care providers (qualified or unqualified) do not feel competent to deal with the newborns. The study findings provide important information on which to base newborn survival interventions in the study area: need to target the communication initiatives on mothers, fathers and grandmothers, need for tailor-made messages based on specific perceptions and barriers, and for building capacity of the primary care providers in managing sick newborns.

Objective: To evaluate impact of simple interventions on neonatal mortality in a low-resource teaching hospital in India.Study design: Before-and-after intervention trial setting: limited resource teaching hospital; Design: Before and after study.Interventions: A package of simple interventions was evolved. The interventions included: rational admissions and early discharge, entrusting mothers in care-giving, enforcing asepsis routines, aggressive enteral feeding, abandoning unnecessary interventions, protocol-based management, rational antibiotics and training and empowerment of nurses.Statistical methods: The categorical and continuous variables were compared with w 2 and two-tailed tests, respectively.Results: Neonatal mortality rate declined significantly during the intervention period as compared to control period (20.3 versus 29.3 per 1000 live births; relative risk 0.69, 95% confidence interval (CI) 0.57 to 0.85). Most significant decline occurred in sepsis-related deaths. The survival of neonates with birth weight 1000 to 1499 improved over two folds (56.7% versus 24.5%, P<0.01). There was a significant decline in antibiotics use (635/878, 72.3% versus 299/897, 23.2%; P ¼ 0.00). The duration of stay in neonatal unit was decreased by a mean of 1.5 day (95% CI 0.9 to 2.8 days) after interventions.Conclusions: Simple interventions can result in a significant decline in neonatal mortality in hospitals with limited resources. This package is likely to be effective in hospitals with a high proportion of the sepsis deaths.