Community health promotion and medical provision for neonatal health—CHAMPION cluster randomised trial in Nagarkurnool district, Telangana (formerly Andhra Pradesh), India

Abstract

BackgroundIn the mid-2000s, neonatal mortality accounted for almost 40% of deaths of children under 5 years worldwide, and constituted 65% of infant deaths in India. The neonatal mortality rate in Andhra Pradesh was 44 per 1,000 live births, and was higher in the rural areas and tribal regions, such as the Nagarkurnool division of Mahabubnagar district (which became Nagarkurnool district in Telangana in 2014). The aim of the CHAMPION trial was to investigate whether a package of interventions comprising community health promotion and provision of health services (including outreach and facility-based care) could lead to a reduction of the order of 25% in neonatal mortality.Methods and findingsThe design was a trial in which villages (clusters) in Nagarkurnool with a population < 2,500 were randomised to the CHAMPION package of health interventions or to the control arm (in which children aged 6–9 years were provided with educational interventions—the STRIPES trial). A woman was eligible for the CHAMPION package if she was married and <50 years old, neither she nor her husband had had a family planning operation, and she resided in a trial village at the time of a baseline survey before randomisation or married into the village after randomisation. The CHAMPION intervention package comprised community health promotion (including health education via village health worker–led participatory discussion groups) and provision of health services (including outreach, with mobile teams providing antenatal check-ups, and facility-based care, with subsidised access to non-public health centres [NPHCs]). Villages were stratified by travel time to the nearest NPHC and tribal status, and randomised (1:1) within strata. The primary outcome was neonatal mortality. Secondary outcomes included maternal mortality, causes of death, health knowledge, health practices including health service usage, satisfaction with care, and costs. The baseline survey (enumeration) was carried out between August and November 2007. After randomisation on 18 February 2008, participants, data collectors, and data analysts were not masked to allocation. The intervention was initiated on 1 August 2008. After an inception period, the assessment start date was 1 December 2008. The intervention ended on 31 May 2011, and data collection was completed on 30 November 2011. Primary analyses followed the intention to treat principle. In all, 14,137 women were enrolled in 232 control villages, and 15,532 in 232 intervention villages. Of these, 4,885 control women had 5,474 eligible pregnancies and gave birth to 4,998 eligible children. The corresponding numbers in intervention villages were 5,664 women, 6,351 pregnancies, and 5,798 children. Of the live-born babies, 343 (6.9%) in the control arm and 303 (5.2%) in the intervention arm died in their first 28 days of life (risk ratio 0.76, 95% CI 0.64 to 0.90, p = 0.0018; risk difference −1.59%, 95% CI −2.63% to −0.54%), suggesting that there were 92 fewer deaths (95% CI 31 to 152) as a result of the intervention. T...

Self-care practice in people with sickle cell anemia

“…As for the self-declared color, three were black and six, brown. Despite being present in people with different colors, sickle cell trait and anemia have a higher prevalence among the black and brown population in the country, which represents a class differentiation for the disease, since blacks and brown (1,2,5) are among the poorest of the Brazilian population and the groups that seek health care services the most.…”

“…"No, I do not know what this disease is. What I know is that I struggle a lot ... but compared to the way he was, he is much better now" (SCA 5 ).…”

“…Because of its prevalence and clinical importance, sickle cell anemia is a public health problem in many countries (1,5) , including Brazil. Also, it is a chronic disease characterized by clinical variability among patients and in the same patient, with periods of well-being interspersed with situations requiring urgent or emergency care (6) .…”

Neonatal mortality contributors using the three delays audit: a study from Albuluk paediatrics teaching hospital in Sudan

“…18 Similar improvements in recognition of danger signs and early care seeking owing to behavior change communications were observed in India and Bangladesh. [19][20][21] More broadly, besides problem recognition, referral for sick newborns also needs to be Strengthening, both from the community and from first level health facilities by improving referral system, ambulance services, triage system, and preparedness of the services to accept and manage the sick newborn.…”

Intervention fidelity and its determinants of focused antenatal care package implementation, in South Wollo Zone, Northeast Ethiopia.&nbsp;&nbsp;

“…Several studies demonstrated that prenatal iron and folic acid supplementation (16)(17)(18)(19)(20)(21)(22), tetanus toxoid vaccination (16,(23)(24)(25)(26), use of insecticide-impregnated bed nets during pregnancy (9), and syphilis screening and treatment (22) have shown to reduce neonatal mortality. Importantly, randomized trials and large observational studies showed signi cant reductions in neonatal mortality and improvement of maternal and childcare uptake after implementing these interventions as package at home-community settings (9,(27)(28)(29)(30)(31)(32)(33)(34)(35).…”