Neonatal and Infant Mortality in the Ten Years (1993 to 2003) of the Gadchiroli Field Trial: Effect of Home-Based Neonatal Care

Bang, Abhay; Reddy, Hanimi M; Deshmukh, Mahesh; Baitule, Sanjay B; Bang, Rani A

doi:10.1038/sj.jp.7211277

Cited by 191 publications

(164 citation statements)

References 20 publications

Supporting

Mentioning

155

Contrasting

Unclassified

Order By: Relevance

“…Seasonal hypothermia rates were not significantly different for LBW compared with normal weight infants in warmer months, but significant differences were found during the colder months. 3 Bang et al 8 reported similar variations from central India (21.5% incidence in the winter versus 13.8% in summer using a definition of hypothermia as <35 1C). In the northern Indian state of Haryana, newborns born at home had an incidence of hypothermia of 19.1% in the winter months, but only 3.1% in the summer.…”

Section: Pathophysiology Of Neonatal Hypothermiamentioning

confidence: 79%

“…3,[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] Uniform adoption and application of the standard WHO definition is fundamental to coordinated advancements in detection and management, but hypothermia continues to be variably defined, leading to under-recognition and under-reporting, and inadvertent denial of care to those who are misclassified but in need of care.…”

Section: Definitionmentioning

confidence: 99%

“…32 Hypothermia beyond the first day of life often indicates infection, particularly septicemia, 32,50,51 and the WHO recommends that all hypothermic infants be assessed for infection. 8 Conversely, hypothermia has been posited to predispose infants to infection due to lethargy, leading to aspiration pneumonia. 50,51 Central nervous system depression also results in bradycardia, apnea and poor feeding.…”

Section: Pathophysiology Of Neonatal Hypothermiamentioning

confidence: 99%

“…3 In Gadchiroli, India, body temperatures were recorded in the home throughout the neonatal period, and 80% of hypothermia cases (axillary temperature <35 1C) occurred on the first day. 8 Among infants who are diagnosed with hypothermia in the days or weeks following birth, their hypothermia is often secondary, that is, a symptom of sepsis or other infection. 8,17 -19 Seasonality Seasonal variation in ambient temperature leads to variation in the incidence of hypothermia.…”

Section: Pathophysiology Of Neonatal Hypothermiamentioning

confidence: 99%

See 3 more Smart Citations

Neonatal hypothermia in low resource settings: a review

et al. 2009

View full text Add to dashboard Cite

Background: Hypothermia is increasingly recognized as a major cause of neonatal morbidity and mortality in resource poor settings. High prevalence of hypothermia has been reported widely from warmer high mortality regions of Africa and South Asia. The World Health Organization recognizes newborn thermal care as a critical and essential component of essential newborn care; however, hypothermia continues to remain under-documented, under-recognized and under-managed.Objective: This review aims to provide a thorough patho-physioepidemiological discussion of neonatal hypothermia applied to local risk factors within the developing country context with particular emphasis on prevention, recognition and management.Method: All available published literature on neonatal hypothermia relevant to resource poor settings were reviewed. Studies from the developing country settings were primarily reviewed for epidemiology, domiciliary risk factors as well as potential interventions for thermal care.Result and Discussion: Functional integrity and efficiency of biological systems is critically dependent on an optimal and very narrow range of core body temperature. Risk factors for neonatal hypothermia differ markedly within low resource settings. A combination of physiological, behavioral and environmental factors universally put all newborns, irrespective of birth weight, at risk of hypothermia. The knowledge deficit along the continuum from health providers to primary care givers has sustained the silent epidemic of hypothermia. The challenges of recognition, understanding of local risk factors and communication have meant a lack of informed thermal care for newborns. Simple, feasible interventions exist, but need to be applied, based on local risk factors that disrupt the warm chain. Further research is needed to document local risk factors, develop better techniques for recognition, evaluation of thermal care within essential newborn care and communication strategies for program effectiveness. Keywords: hypothermia; skin-to-skin care; warm chain; community; newborn; neonatal health Introduction 'If a definition of life were required, it must be most clearly on that capacity, by which the animal preserves its proper heat under the various degrees of temperature of the medium in which it livesy a few degrees of increase or diminution of the heat of the system, produces disease and death' said James Currie some two centuries ago, recognizing the central importance of temperature regulation in health. 1 Although folklore associated with increased temperature or fever has been recorded throughout history across virtually every culture and civilization, a recognition of hypothermia and its clinical significance, particularly for newborn health is a relatively recent advance. 1,2 Moreover, progress toward thermal care of newborns in developed countries has far outstripped knowledge and practice in developing country settings, where 99% of global neonatal deaths occur. 3,4 Hypothermia during the newborn period is widely regarded as a...

show abstract

Section: Pathophysiology Of Neonatal Hypothermiamentioning

confidence: 79%

Section: Definitionmentioning

confidence: 99%

Section: Pathophysiology Of Neonatal Hypothermiamentioning

confidence: 99%

Section: Pathophysiology Of Neonatal Hypothermiamentioning

confidence: 99%

See 2 more Smart Citations

Neonatal hypothermia in low resource settings: a review

et al. 2009

View full text Add to dashboard Cite

show abstract

“…In the subsequent article, 24 we have estimated that the homebased interventions in the Gadchiroli trial averted 31 asphyxia related neonatal deaths in 39 villages during 1996 to 2003. (If bag and mask were used from the beginning of intervention, probably more deaths would have been averted.)…”

Section: Discussionmentioning

confidence: 99%

Management of Birth Asphyxia in Home Deliveries in Rural Gadchiroli: The Effect of Two Types of Birth Attendants and of Resuscitating with Mouth-to-Mouth, Tube-Mask or Bag–Mask

et al. 2005

Self Cite

View full text Add to dashboard Cite

OBJECTIVES:To evaluate the effect of home-based neonatal care on birth asphyxia and to compare the effectiveness of two types of workers and three methods of resuscitation in home delivery. STUDY DESIGN:In a field trial of home-based neonatal care in rural Gadchiroli, India, birth asphyxia in home deliveries was managed differently during different phases. Trained traditional birth attendants (TBA) used mouthto-mouth resuscitation in the baseline years (1993 to 1995). Additional village health workers (VHWs) only observed in 1995 to 1996. In the intervention years (1996 to 2003), they used tube-mask (1996 to 1999) and bag-mask (1999 to 2003). The incidence, case fatality (CF) and asphyxia-specific mortality rate (ASMR) during different phases were compared. RESULTS:During the intervention years, 5033 home deliveries occurred. VHWs were present during 84% home deliveries. The incidence of mild birth asphyxia decreased by 60%, from 14% in the observation year (1995 to 1996) to 6% in the intervention years (p<0.0001). The incidence of severe asphyxia did not change significantly, but the CF in neonates with severe asphyxia decreased by 47.5%, from 39 to 20% (p<0.07) and ASMR by 65%, from 11 to 4% (p<0.02). Mouth-to-mouth resuscitation reduced the ASMR by 12%, tube-mask further reduced the CF by 27% and the ASMR by 67%. The bag-mask showed an additional decrease in CF of 39% and in the fresh stillbirth rate of 33% in comparison to tube-mask (not significant). The cost of bag and mask was $13 per averted death. Oxytocic injection administered by unqualified doctors showed an odds ratio of three for the occurrence of severe asphyxia or fresh stillbirth. CONCLUSIONS:Home-based interventions delivered by a team of TBA and a semiskilled VHW reduced the asphyxia-related neonatal mortality by 65% compared to only TBA. The bag-mask appears to be superior to tube-mask or mouth-to-mouth resuscitation, with an estimated equipment cost of $13 per death averted.

show abstract

Integrated, Evidence-Based Approaches to Save Newborn Lives in Developing Countries

Haws¹

2007

Arch Pediatr Adolesc Med

View full text Add to dashboard Cite

Neonatal and Infant Mortality in the Ten Years (1993 to 2003) of the Gadchiroli Field Trial: Effect of Home-Based Neonatal Care

Cited by 191 publications

References 20 publications

Neonatal hypothermia in low resource settings: a review

Neonatal hypothermia in low resource settings: a review

Management of Birth Asphyxia in Home Deliveries in Rural Gadchiroli: The Effect of Two Types of Birth Attendants and of Resuscitating with Mouth-to-Mouth, Tube-Mask or Bag–Mask

Integrated, Evidence-Based Approaches to Save Newborn Lives in Developing Countries

Contact Info

Product

Resources

About