Hypertensive disorders of pregnancy contribute significantly to maternal mortality and morbidity. Preeclampsia belongs to the spectrum of hypertensive disorders of pregnancy and if undiagnosed and/or untreated leads to fatal consequences for both the mother and the baby. Early detection and prevention of preeclampsia is limited by uncertainty in the knowledge about its etiopathogenesis. While much work has been done in establishing clinical guidelines for management of preeclampsia in the hospital or tertiary care settings, there is considerable lack of work in the domain of evidence-based guidelines for screening, identification and management of preeclampsia at the community-level. The article reviews these issues with special considerations and to challenges faced in low and middle-income countries. There is a need to focus on low-cost screening and interventions in the community to achieve a significant impact on preventable maternal and fetal mortality in order to control the burden of preeclampsia significantly as well as investing on more research at primary care level to improve the evidence base for community-level interventions.

Please cite this paper as: Lassi ZS, Bhutta ZA. Unfolding the universe of newborn health interventions: the role of innovative community-based strategies. BJOG 2011;118 (Suppl. 2):18-21.Globally, an estimated 3.6 million newborns and 360 000 mothers die every year. Of these, maternal health complications contribute to 1.5 million neonatal deaths in the first week of life and 1.4 million stillbirths, suggesting that a major gap of intervention exists around childbirth and in the early postnatal period, a time at which mothers and babies are most at risk.1,2 The main direct causes of neonatal death include birth asphyxia, preterm birth complications and severe infections, including sepsis, pneumonia, diarrhoea and tetanus. In terms of low birthweight, according to the United Nations Children's Fund (UNICEF) estimates of 2009, sub-Saharan Africa and South Asia bear the greatest burden, with 80% of all neonatal deaths occurring in these two regions alone.3 Global progress in reducing neonatal mortality has been slow, and the burden is particularly marked in poor, rural communities that are the most difficult to reach and among the most disadvantaged, with the lowest access to and utilisation of facility-based services for childbirth and newborn care.In addition to poverty, several underlying social determinants contribute to the burden of neonatal morbidity and mortality. These include factors such as low literacy and women's status in society, nutritional status pre-conception and at the time of conception, early marriages and childbearing, high fertility and closely spaced pregnancies. Many harmful neonatal care practices, such as inadequate cord care, discarding the colostrum and feeding pre-lacteals, are deeply rooted in the cultural fabric of societies 4 and further increase the risk of neonatal deaths. These risks are greatly compounded by poorly functional health systems and shortages of skilled human resources for health. This is a particular cause for concern in poor populations which are disproportionately affected by the outmigration of health professionals and the inability to provide good-quality primary care services. 5Given the shortage of care providers and functional health facilities, and the deeply entrenched practices, there is much interest in community-based interventions and strategies for care. A growing body of evidence suggests that many direct causes of neonatal deaths can be adequately managed by community health workers (CHWs) employing a range of promotive, preventative and therapeutic interventions at community level. These include the promotion of behavioural change through community counselling on topics related to birth and newborn care preparedness, as well as additional provision of preventative and therapeutic interventions at household level for newborn care. However, it is recognised that functional facilities with around-the-clock provision of emergency obstetric and newborn care, and adequate transport services, are also a critical necessity to reduce maternal morbidity and m...