Effect of home-based counselling on newborn care practices in southern Tanzania one year after implementation: a cluster-randomised controlled trial

Abstract

BackgroundIn Sub-Saharan Africa over one million newborns die annually. We developed a sustainable and scalable home-based counselling intervention for delivery by community volunteers in rural southern Tanzania to improve newborn care practices and survival. Here we report the effect on newborn care practices one year after full implementation.MethodsAll 132 wards in the 6-district study area were randomised to intervention or comparison groups. Starting in 2010, in intervention areas trained volunteers made home visits during pregnancy and after childbirth to promote recommended newborn care practices including hygiene, breastfeeding and identification and extra care for low birth weight babies. In 2011, in a representative sample of 5,240 households, we asked women who had given birth in the previous year both about counselling visits and their childbirth and newborn care practices.ResultsFour of 14 newborn care practices were more commonly reported in intervention than comparison areas: delaying the baby’s first bath by at least six hours (81% versus 68%, OR 2.0 (95% CI 1.2-3.4)), exclusive breastfeeding in the three days after birth (83% versus 71%, OR 1.9 (95% CI 1.3-2.9)), putting nothing on the cord (87% versus 70%, OR 2.8 (95% CI 1.7-4.6)), and, for home births, tying the cord with a clean thread (69% versus 39%, OR 3.4 (95% CI 1.5-7.5)). For other behaviours there was little evidence of differences in reported practices between intervention and comparison areas including childbirth in a health facility or with a skilled attendant, thermal care practices, breastfeeding within an hour of birth and, for home births, the birth attendant having clean hands, cutting the cord with a clean blade and birth preparedness activities.ConclusionsA home-based counselling strategy using volunteers and designed for scale-up can improve newborn care behaviours in rural communities of southern Tanzania. Further research is needed to evaluate if, and at what cost, these gains will lead to improved newborn survival.Trial registrationTrial Registration Number NCT01022788 (http://www.clinicaltrials.gov, 2009)

Impact of Infant and Young Child Feeding (IYCF) Nutrition Interventions on Breastfeeding Practices, Growth and Mortality in Low- and Middle-Income Countries: Systematic Review

“…The breastfeeding education studies were con4ducted in a wide range of countries spanning four continents, i.e., twelve studies in Africa; one in Egypt [22]; two in Ghana [23,57]; two in Uganda [37,63]; one in Nigeria [38]; two in Tanzania [44,73]; two in Kenya [56,70]; one in South Africa [49]; one study in three countries of Africa [92]; Burkina Faso, Uganda and South Africa. Twenty-four studies were conducted in Asia; six in Bangladesh [26,27,51,53,89,95]; three in India [29,65,67]; one in Nepal [32]; two in Iran [39,75]; one in China [42]; one in Jordan [54]; one in Thailand [58]; one in Pakistan [83]; one in Malaysia [87]; two in Turkey [24,33]; one in Philippines [21].…”

Determinants of Clean Birthing Practices in Low- and Middle-Income Countries: a Scoping Review

“…Five studies described multi-modal interventions within a health care facility, either for general quality improvement [58][59][60] [63][64][65] and three studies of healthcare facility-based interventions [66][67][68]. One study evaluated a community and facility-based intervention [69].…”

“…One study evaluated a community and facility-based intervention [69]. The most commonly targeted determinant was knowledge of the mother or birth attendant, with four interventions aiming to improve knowledge through increased use of maternal and newborn services [69], home-based maternal counselling by community volunteers [63], improved quality of facilitybased maternal counselling through use of visual job-aids [68], or facility-based training of care providers on essential newborn care practices [67]. Two studies highlight the critical importance of participatory approaches, meaning the active involvement of women, families, and community members in effecting behaviour change, in contrast to models based purely on education [64,65].…”

“…Job motivation emerges as a minor theme, featuring in one healthcare facility-based study in India that advocates moving beyond knowledge and skills-building and job-aids to peer coaching and performance monitoring [66]. Another minor theme, featuring in one community-based study, is the role of the woman's life-stage -namely pregnancy -as a teachable moment [63].…”

Effects of community health volunteers on infectious diseases of children under five in Volta Region, Ghana: study protocol for a cluster randomized controlled trial

“…A number of studies have demonstrated that community-based health systems, particularly those involving CHWs, have led to improved access to maternal healthcare services [13–15], modern contraception [16, 17], and neonatal care among the poor [18–22]. However, recently only few studies have investigated the impact of interventions made by CHWs on childhood illness in sub-Saharan Africa, using randomized controlled trials (RCTs) [23–26].…”