Effect of home-based newborn care on neonatal and infant mortality: a cluster randomised trial in India

Abstract

BackgroundHome-based newborn care has been found to reduce neonatal mortality in rural areas. Study evaluated effectiveness of home-based care delivered by specially recruited newborn care workers- Shishu Rakshak (SR) and existing workers- anganwadi workers (AWW) in reducing neonatal and infant mortality rates.MethodsThis three-arm, community-based, cluster randomised trial was conducted in five districts in India. Intervention package consisted of pregnancy surveillance, health education, care at birth, care of normal/low birthweight neonates, identification and treatment of sick neonates and young infants using oral and injectable antibiotics and community mobilisation. The package was similar in both intervention arms—SR and AWW; difference being healthcare provider. The control arm received routine health services from the existing health system. Primary outcomes were neonatal and young infant mortality rates at ‘endline’ period (2008–2009) assessed by an independent team from January to April 2010 in the study clusters.FindingsA total of 6623, 6852 and 5898 births occurred in the SR, AWW and control arms, respectively, during the endline period; the proportion of facility births were 69.0%, 64.4% and 70.6% in the three arms. Baseline mortality rates were comparable in three arms. During the endline period, the risk of neonatal mortality was 25% lower in the SR arm (adjusted OR 0.75, 95% CI 0.57 to 0.99); the risks of early neonatal mortality, young infant mortality and infant mortality were also lower by 32%, 27%, and 33%, respectively. The risks of neonatal, early neonatal, young infant, infant mortality in the AWW arm were not different from that of the control arm.InterpretationHome-based care is effective in reducing neonatal and infant mortality rates, when delivered by a dedicated worker, even in settings with high rates of facility births.Trial registration numberThe study was registered with Clinical Trial Registry of India (CTRI/2011/12/002181).

Home based postpartum care and determinants in Ethiopia: A multilevel analysis

“…The current study is lower than the studies conducted in southern Ethiopia (12.4%) [ 34 ], Northern Ethiopia (14.5%) [ 32 ], and Pakistan (25%) [ 10 ]. The difference could be the current study targets women who gave birth in the last 2 years preceding the survey with a large sample size which may have recall bias, whereas the study conducted in southern Ethiopia targets women who had live birth less than 6months of age.…”

The impact of health sector‐wide approaches on aid effectiveness and infant mortality

“…To place this in context, recent quasi‐experimental evidence comparing Ghana and Burkina Faso against Nigeria and Zambia (Dwomoh et al, 2020) suggests that free maternal healthcare can cut the risk of infant mortality by more than half (RR = 0.46, 95%CI: 0.36 to 0.59). A recent randomised trial conducted in five districts of India reported smaller but still large magnitude reductions in odds of infant mortality (OR = 0.67, 95%CI: 0.54 to 0.83) for home‐based newborn care delivered by dedicated health workers (Rasaily et al, 2020). Recent efforts to identify the causal effect of maternal education on infant and child mortality suggest that an additional year of maternal education reduces the risk of under age 5 mortality by 10.0% and 16.6% in Malawi and Uganda, respectively (Andriano & Monden, 2019).…”

Predicting Perinatal Mortality Based on Maternal Health Status and Health Insurance Service using Homogeneous Ensemble Machine Learning Methods

“…Perinatal mortality refers to a fatal death at or after 28 weeks of pregnancy (stillbirth) and includes death within 7 days of life after birth [1] [2]. According to the World Health Organization (WHO) 2019 report, there were 2.6 million newborn infants globally, but more than 8200 died within a day [3]. Among the 133 million newborn infants alive each year, 2.8 million died in the rst week of life after birth/at birth, and the majority occurred in low-income level countries [3].…”

“…According to the World Health Organization (WHO) 2019 report, there were 2.6 million newborn infants globally, but more than 8200 died within a day [3]. Among the 133 million newborn infants alive each year, 2.8 million died in the rst week of life after birth/at birth, and the majority occurred in low-income level countries [3]. Given the reaching deadlines for reaching the Millennium Development Goals, the international community supports low-and middle-level income countries to renew their commitment to reducing maternal and infants mortality rates by improving access to maternal, neonatal, and perinatal health services [4].…”