Home-based neonatal care by community health workers for preventing mortality in neonates in low- and middle-income countries: a systematic review

Gogia, Siddhartha; Sachdev, H. P. S.

doi:10.1038/jp.2016.33

Cited by 62 publications

(46 citation statements)

References 86 publications

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“…Literature in other low and middle-income counties in Sub-Saharan Africa and Asia has shown that home visits by community health workers during pregnancy and the early postpartum period, and engagement with women’s groups, contributed to improvements in key behaviors such as skilled birth and newborn care practices [ 37 – 41 ]. Our study, which measures the effect of the Family Conversation intervention on intermediate maternal and newborn health outcomes, is in agreement with studies in other low-income countries.…”

Section: Discussionmentioning

confidence: 99%

Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis

Altaye¹,

Karim²,

Betemariam³

et al. 2018

BMC Pregnancy Childbirth

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BackgroundMaternal and newborn mortality rates in Ethiopia are among the highest in sub-Saharan Africa. The majority of deaths take place during childbirth or within the following 48 h. Therefore, ensuring facility deliveries with emergency obstetric and newborn care services available and immediate postnatal follow-up are key strategies to increase survival. In early 2014, the Family Conversation was implemented in 115 rural districts in Ethiopia, covering about 17 million people. It aimed to reduce maternal and newborn mortality by promoting institutional delivery, early postnatal care and immediate newborn care practices. More than 6000 Health Extension Workers were trained to initiate home-based Family Conversations with pregnant women and key household decision-makers. These conversations included discussions on birth preparedness, postpartum and newborn care needs to engage key household stakeholders in supporting women during their pregnancy, labor and postpartum periods. This paper examines the effects of the Family Conversation strategy on maternal and neonatal care practices.MethodsWe used cross-sectional data from a representative sample of 4684 women with children aged 0–11 months from 115 districts collected between December 2014 and January 2015. We compared intrapartum and newborn care practices related to the most recent childbirth, between those who reported having participated in a Family Conversation during pregnancy, and those who had not. Propensity score matched analysis was used to estimate average treatment effects of the Family Conversation strategy on intrapartum and newborn care practices, including institutional delivery, early postnatal and immediate breastfeeding.ResultsAbout 17% of the respondents reported having had a Family Conversation during their last pregnancy. Average treatment effects of 7, 12, 9 and 16 percentage-points respectively were found for institutional deliveries, early postnatal care, clean cord care and thermal care of the newborn (p < 0.05).ConclusionWe found evidence that Family Conversation, and specifically the involvement of household members who were major decision-makers, was associated with better intrapartum and newborn care practices. This study adds to the evidence base that involving husbands and mothers-in-law, as well as pregnant women, in behavior change communication interventions could be critical for improving maternal and newborn care and therewith lowering mortality rates.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1978-8) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis

Altaye¹,

Karim²,

Betemariam³

et al. 2018

BMC Pregnancy Childbirth

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“…We found three reviews about community-based services. Cogia et al [88] included five cluster randomised controlled trials (RCTs), assessed at low risk of bias, and concluded that various interventions by community healthcare workers during pregnancy, birth and the neonatal period significantly reduced neonatal mortality. The review by Lassi et al, [89] in which 24 of the 26 studies were cluster RCTs, concluded that training community-level healthcare workers on basic antenatal, natal and postnatal care, preventive newborn care and community mobilisation, significantly reduced maternal morbidity and neonatal and perinatal mortality.…”

Section: Possible Game Changers Mobile Health (Mhealth) and Communitymentioning

confidence: 99%

Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

et al. 2019

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This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0. Although the neonatal mortality rate in South Africa (SA) has remained stagnant at 12 deaths per 1 000 live births, the infant and under-5 mortality rates have significantly declined since peaking in 2003. Policy changes that have influenced this decline include policies to prevent vertical HIV transmission, earlier treatment of children living with HIV, expanded immunisation policies, strengthening breastfeeding practices, and health policies to contain tobacco and sugar use. The Sustainable Development Goals (2016-2030) have shifted the focus from keeping children alive, as expressed in the Millennium Development Goals (1990-2015), to achieving optimal health through the 'Survive, thrive and transform' global agenda. This paper focuses on important remaining causes of childhood mortality and morbidity in SA, specifically respiratory illness, environmental pollution, tuberculosis, malnutrition and vaccine-preventable conditions. The monitoring of maternal and child health (MCH) outcomes is crucial, and has improved in SA through both the District Health Information and Civil Registration and Vital Statistics systems, although gaps remain. Intermittent surveys and research augment the routinely collected data. However, availability and use of local data to inform quality and effectiveness of care is critical, and this requires ownership at the collection point to facilitate local redress. Potential game changers to improve MCH outcomes include mobile health and community-based interventions. In SA, improved MCH remains a crucial factor for human capital development. There is a pressing need to focus beyond childhood mortality and to ensure that each child thrives.

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“…This paper analyzes the findings related to the effectiveness of community–based primary health care (CBPHC) in improving neonatal health using a subset of articles from a database assembled for a broader review of the effectiveness of community–based primary health (CBPHC) in improving child health. It complements other reviews that have been carried out on this topic [7–9]. Projects were assessed by their study design, outcome variables, program components, and reported neonatal health impact.…”

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confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 3. neonatal health findings

Jennings

Pradhan

Schleiff

et al. 2017

Journal of Global Health

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BackgroundAs the number of deaths among children younger than 5 years of age continues to decline globally through programs to address the health of older infants, neonatal mortality is becoming an increasingly large proportion of under–5 deaths. Lack of access to safe delivery care, emergency obstetric care and postnatal care continue to be challenges for reducing neonatal mortality. This article reviews the available evidence regarding the effectiveness of community–based primary health care (CBPHC) and common components of programs aiming to improve health during the first 28 days of life.MethodsA database comprising evidence of the effectiveness of projects, programs and field research studies (referred to collectively as projects) in improving maternal, neonatal and child health through CBPHC has been assembled and described elsewhere in this series. From this larger database (N = 548), a subset was created from assessments specifically relating to newborn health (N = 93). Assessments were excluded if the primary project beneficiaries were more than 28 days of age, or if the assessment did not identify one of the following outcomes related to neonatal health: changes in knowledge about newborn illness, care seeking for newborn illness, utilization of postnatal care, nutritional status of neonates, neonatal morbidity, or neonatal mortality. Descriptive analyses were conducted based on study type and outcome variables. An equity assessment was also conducted on the articles included in the neonatal subset.ResultsThere is strong evidence that CBPHC can be effective in improving neonatal health, and we present information about the common characteristics shared by effective programs. For projects that reported on health outcomes, twice as many reported an improvement in neonatal health as did those that reported no effect; only one study demonstrated a negative effect. Of those with the strongest experimental study design, almost three–quarters reported beneficial neonatal health outcomes. Many of the neonatal projects assessed in our database utilized community health workers (CHWs), home visits, and participatory women’s groups. Several of the interventions used in these projects focused on health education (recognition of danger signs), and promotion of and support for exclusive breastfeeding (sometimes, but not always, including early breastfeeding). Almost all of the assessments that included a measurable equity component showed that CBPHC produced neonatal health benefits that favored the poorest segment of the project population. However, the studies were quite biased in geographic scope, with more than half conducted in South Asia, and many were pilot studies, rather than projects at scale.ConclusionsCBPHC can be effectively employed to improve neonatal health in high–mortality, resource–constrained settings. CBPHC is especially important for education and support for pregnant and postpartum mothers and for establishing community–facility linkages to facilitate referrals for obstetrical emergencies; howe...

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Home-based neonatal care by community health workers for preventing mortality in neonates in low- and middle-income countries: a systematic review

Cited by 62 publications

References 86 publications

Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis

Effects of family conversation on health care practices in Ethiopia: a propensity score matched analysis

Neonatal, infant and child health in South Africa: Reflecting on the past towards a better future

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 3. neonatal health findings

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