Effect of timing of first postnatal care home visit on neonatal mortality in Bangladesh: a observational cohort study

Abstract

Objective To assess the effect of the timing of first postnatal home visit by community health workers on neonatal mortality. Design Analysis of prospectively collected data using time varying discrete hazard models to estimate hazard ratios for neonatal mortality according to day of first postnatal home visit. Data source Data from a community based trial of neonatal care interventions conducted in Bangladesh during 2004-5. Main outcome measure Neonatal mortality. Results 9211 live births were included. Among infants who survived the first day of life, neonatal mortality was 67% lower in those who received a visit on day one than in those who received no visit (adjusted hazard ratio 0.33, 95% confidence interval 0.23 to 0.46; P<0.001). For those infants who survived the first two days of life, receiving the first visit on the second day was associated with a 64% lower neonatal mortality than in those who did not receive a visit (adjusted hazard ratio 0.36, 0.23 to 0.55; P<0.001). First visits on any day after the second day of life were not associated with reduced mortality. Conclusions In developing countries, especially where home delivery with unskilled attendants is common, postnatal home visits within the first two days of life by trained community health workers can significantly reduce neonatal mortality.

Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster-randomised effectiveness trial

“…We speculate therefore that the pathway for eff ectiveness of the Hala intervention was largely through improved antenatal contact with LHWs leading to improved childbirth care for mothers, including increased facility births in the hands of skilled attendants, and improvements in some elements of immediate newborn care. 33 The lack of improvement in careseeking for newborn illnesses in the intervention clusters could be related to …”

The interconnections between maternal and newborn health – evidence and implications for policy

“…The study reported higher rates of detection of mothers being pallor during the postnatal visits (p ¼ 0.004); however, it had no impact on identifying and improving other maternal morbidities or improving contraceptive rates. In another study, postnatal visits on days 1 and 2 of life had significant effects on neonatal mortality (infants receiving a visit on day 1 versus none: HR 0.33; 95% CI: 0.23 to 0.46) [227].…”

“…Lack of access to, and availability of, high-quality EmOC, especially cesarean section, has been considered as a risk factor for intrapartum stillbirths, particularly those associated with prolonged/obstructed labor [227].…”

Care of the Newborn in Developing Countries

“…The strategy has shown positive results in high mortality settings by reducing newborn deaths and improving key newborn care practices [36,37]. While home births are very common in developing countries, only 13% of women in these countries receive postnatal care in the first 24 hours [36].…”

“…Home care visits should occur on days one and three of a newborn's life, and if possible, a third visit should take place before the end of the first week of life (day seven) [36,37]. This is however not practiced in many developing countries like Nigeria, hence the high neonatal mortality [22,37]. Once delivered, the baby should be cleaned up, clothed and put to breast within the first thirty minutes of life.…”