Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial

Baqui, Abdullah H; Arifeen, Shams El; Darmstadt, Gary L.; Ahmed, Saifuddin; Williams, Emma; Seraji, Habibur R; Mannan, Ishtiaq; Rahman, Sezanur; Shah, Rashed; Saha, Samir K.; Syed, Uzma; Winch, Peter J.; LeFevre, Amnesty; Santosham, Mathuram; Black, Robert E.

doi:10.1016/s0140-6736(08)60835-1

Cited by 521 publications

(590 citation statements)

References 23 publications

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“…In remote rural settings measures are needed at facilitating transport access and a number of measures have been identified including community revolving funds for transport, transporter-community links facilitated by NGOs, and transport vouchers (29)(30)(31). BCC has proved to be effective for birth preparedness and newborn care (32), and in this case calls for inclusion of husbands and inlaws. Furthermore, programs to economically and socially empower women such as microfinance schemes can enhance their decision-making power for MNH services (33,34).…”

Section: Discussionmentioning

confidence: 99%

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Riaz

Zaidi

Khowaja

2015

Int J Health Policy Manag

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Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users' perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted). Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two contracted-out and four matched non-contracted primary healthcare facilities in Thatta and Chitral, rural districts of Pakistan. Using semi-structured guide, the data were collected through thirty-six Focus Group Discussions (FGDs) conducted with mothers and their spouses in the catchment areas of selected facilities. Thematic analysis was performed using NVivo version 10.0 in which themes and sub-themes emerged. Results: Key barriers reported in contracted sites included physical distance, user charges and familial influences. Whereas, poor functionality of health centres was the main barrier for non-contracted sites with other issues being comparatively less salient. Decision-making patterns for participants of both catchments were largely similar. Spouses and mother-in-laws particularly influenced the decision to utilize health facilities. Conclusion: Contracting out of health facility reduces supply side barriers to MNH services for the community served but distance, user charges and low awareness remain significant barriers. Contracting needs to be accompanied by measures for transportation in remote settings, oversight on user fee charges by contractor, and strong communitybased behavior change strategies. Implications for policy makers• Contracting out public health facilities can be an effective strategy to improve service delivery for Maternal and Neonatal Health (MNH), however, not sufficient to improve the service utilization. • With poor physical and financial access to health facilities in rural settings, transportation and financial safety nets need to be established. • Cultural and customary trends strongly influence decision-making for MNH services utilization. Therefore, community-based behavior change strategies targeting mothers, spouses and mother-in-laws seem crucial.

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Section: Discussionmentioning

confidence: 99%

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Riaz

Zaidi

Khowaja

2015

Int J Health Policy Manag

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“…21 Evaluations of other neonatal care packages have been reported. [22][23][24][25] Reductions in neonatal or perinatal mortality rates were reported in randomized trials of training of community-health workers and traditional birth attendants. [23][24][25] However, a review of studies 26 that tested neonatal care packages concluded that effectiveness trials are required to test these packages at scale in developing countries, such as was performed in this study.…”

Section: Figurementioning

confidence: 99%

Newborn Care Training of Midwives and Neonatal and Perinatal Mortality Rates in a Developing Country

et al. 2010

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WHAT'S KNOWN ON THIS SUBJECT:The majority of infant deaths occur during the neonatal period. Educational programs available to train neonatal health care workers are effective in improving knowledge and skills, but there are limited data on their effects on neonatal mortality rates. WHAT THIS STUDY ADDS:Training midwives in neonatal care reduces early neonatal mortality rates for infants born in lowrisk, first-level facilities. abstract + OBJECTIVE: This study was designed to test the hypothesis that 2 training programs would reduce incrementally 7-day neonatal mortality rates for low-risk institutional deliveries. METHODS:Using a train-the-trainer model, certified research midwives sequentially trained the midwives who performed deliveries in low-risk, first-level, urban, community health clinics in 2 cities in Zambia in the protocol and data collection, in the World Health Organization Essential Newborn Care (ENC) course (universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of small infants, and common illnesses), and in the American Academy of Pediatrics Neonatal Resuscitation Program (in-depth basic resuscitation). Data were collected during 3 periods, after implementation of each training course. RESULTS:A total of 71 689 neonates were enrolled in the 3 study periods. All-cause, 7-day neonatal mortality rates decreased from 11.5 deaths per 1000 live births to 6.8 deaths per 1000 live births after ENC training (relative risk: 0.59 [95% confidence interval: 0.48 -0.77]; P Ͻ .001), because of decreases in rates of deaths attributable to birth asphyxia and infection. Perinatal mortality rates but not stillbirth rates decreased. The 7-day neonatal mortality rate was decreased further after Neonatal Resuscitation Program training, after correction for loss to follow-up monitoring.CONCLUSIONS: ENC training for midwives reduced 7-day neonatal mortality rates in low-risk clinics. Additional in-depth basic training in neonatal resuscitation may reduce mortality rates further. Pediatrics

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“…49,54 The high proportion of births occurring outside the formal health care sector in many high-mortality settings provides further impetus for expanding research on emollients to the community level; however, strategies are needed to address the use of potentially toxic emollients (e.g. use of mustard oil, mixing the emollient with potentially harmful additives) and harmful application techniques, such as too vigorous massage, which can damage the skin barrier, especially in preterm infants.…”

Section: Resultsmentioning

confidence: 99%

Cost-effectiveness of skin-barrier-enhancing emollients among preterm infants in Bangladesh

LeFevre

Shillcutt

Saha

et al. 2010

Bull. World Health Organ.

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Objective To evaluate the cost-effectiveness of topical emollients, sunflower seed oil (SSO) and synthetic Aquaphor, versus no treatment, in preventing mortality among hospitalized preterm infants (< 33 weeks gestation) at a tertiary hospital in Bangladesh. Methods Evidence from a randomized controlled efficacy trial was evaluated using standard Monte Carlo simulation. Programme costs were obtained from a retrospective review of activities. Patient costs were collected from patient records. Health outcomes were calculated as deaths averted and discounted years of life lost (YLLs) averted. Results were deemed cost-effective if they fell below a ceiling ratio based on the per capita gross national income of Bangladesh (United States dollars, US$ 470). Findings Aquaphor and SSO were both highly cost-effective relative to control, reducing neonatal mortality by 26% and 32%, respectively. SSO cost US$ 61 per death averted and US$ 2.15 per YLL averted (I$ 6.39, international dollars, per YLL averted). Aquaphor cost US$ 162 per death averted and US$ 5.74 per YLL averted (I$ 17.09 per YLL averted). Results were robust to sensitivity analysis. Aquaphor was cost-effective relative to SSO with 77% certainty: it cost an incremental US$ 26 more per patient treated, but averted 1.25 YLLs (US$ 20.74 per YLL averted). Conclusion Topical therapy with SSO or Aquaphor was highly cost-effective in reducing deaths from infection among the preterm neonates studied. The choice of emollient should be made taking into account budgetary limitations and ease of supply. Further research is warranted on additional locally available emollients, use of emollients in community-based settings and generalizability to other geographic regions.Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español. ‫املقالة.‬ ‫لهذه‬ ‫الكامل‬ ‫النص‬ ‫نهاية‬ ‫يف‬ ‫الخالصة‬ ‫لهذه‬ ‫العربية‬ ‫الرتجمة‬

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Effect of community-based newborn-care intervention package implemented through two service-delivery strategies in Sylhet district, Bangladesh: a cluster-randomised controlled trial

Cited by 521 publications

References 23 publications

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Perceived barriers to utilizing maternal and neonatal health services in contracted-out versus government-managed health facilities in the rural districts of Pakistan

Newborn Care Training of Midwives and Neonatal and Perinatal Mortality Rates in a Developing Country

Cost-effectiveness of skin-barrier-enhancing emollients among preterm infants in Bangladesh

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