Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan

Abstract

Background: In 2018, Pakistan had the world's highest neonatal mortality rate. Within Pakistan, most neonatal deaths occur in rural areas where access to health facilities is limited, and robust vital registration systems are lacking. To improve newborn survival, there is a need to better understand the causes of neonatal death in high burden settings and engage caregivers in the promotion of newborn health. Objective: To describe the causes of neonatal death in a rural area in Pakistan and to estimate the effect of an integrated neonatal care kit (iNCK) on cause-specific neonatal mortality. Methods: We analyzed data from a community-based, cluster-randomized controlled trial of 5286 neonates in Rahim Yar Khan (RYK), Punjab, Pakistan between April 2014 and August 2015. In intervention clusters, Lady Health Workers (LHW) delivered the iNCK and education on its use to pregnant women while control clusters received the local standard of care. The iNCK included interventions to prevent and identify signs of infection, identify low birthweight (LBW), and identify and manage hypothermia. Verbal autopsies were attempted for all deaths. The primary outcome was cause-specific neonatal mortality. Results: Verbal autopsies were conducted for 84 (57%) of the 147 reported neonatal deaths. The leading causes of death were infection (44%), intrapartum-related complications (26%) and prematurity/LBW (20%). There were no significant differences in neonatal mortality due to prematurity/LBW (RR 0.43; 95% CI 0.15-1.24), infection (RR 1.10; 95% CI 0.58-2.10) or intrapartum-related complications (RR 1.04; 95% CI 0.0.45-2.41) among neonates who died in the intervention arm compared to those who died in the control arm. Conclusion: The major causes of neonatal deaths in RYK, Pakistan mirror the global landscape of neonatal deaths. The iNCK did not significantly reduce any cause-specific neonatal mortality.

Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomised controlled trial in Northern Uganda

“…Similar to the study in Pakistan that examined the effect of an integrated neonatal care kit, 32 our trial did not find an association between the intervention and perinatal mortality or neonatal mortality. Similarly, there was no association between the intervention and the number of postnatal visits.…”

“…The third component of the intervention, provision of mama kits: Use of mama kits (birth kits or birthing kits) during delivery has been associated with reduced newborn morbidity, mortality and maternal puerperal sepsis in some areas 30 31 but not in others. 32 While mama kits are an essential part of delivery care in many resource-limited countries, they are very often unavailable in many health facilities and mothers may be required to procure them on their own from private pharmacies. This may constitute an additional barrier to accessing health facilities for birth.…”

An integrated newborn care kit (iNCK) to save newborn lives and improve health outcomes in Gilgit Baltistan (GB), Pakistan: study protocol for a cluster randomized controlled trial

“…Cause of death will be ascertained using VA data using previously described methods and will also inform the primary analysis by differentiating stillbirths from early neonatal deaths [ 30 ]. Stata version 17.0 or newer will be used for all analyses.…”

Cause-Specific Mortality Patterns among Hospital Deaths in District Mardan, Khyber Pakhtunkhwa, Pakistan

“…Pakistan has the world's third highest rate of newborn death. It is critical to investigate factors related with newborn death before implementing evidence-based strategies to reduce mortality rates [10][11]. RSV (respiratory syncytial virus) is a major cause of newborn mortality rates, and it is a potential target for maternal immunization methods.…”