Home-Based Neonatal Care: Summary and Applications of the Field Trial in Rural Gadchiroli, India (1993 to 2003)

Abstract

High levels of neonatal mortality and lack of access to neonatal health care are widespread problems in developing countries. A field trial of home-based neonatal care (HBNC) was conducted in rural Gadchiroli, India to develop and test the feasibility of a low-cost approach of delivering primary neonatal care by using the human potential available in villages, and to evaluate its effect on neonatal mortality. In the first half of this article we summarize various aspects of the field trial, presented in the previous 11 articles in this issue of the journal supplement. The background, objectives, study design and interventions in the field trial and the results over 10 years (1993 to 2003) are presented. Based on these results, the hypotheses are tested and conclusions presented. In the second half, we discuss the next questions: Can it be replicated? Can this intervention become a part of primary healthcare services? What is the cost and the cost-effectiveness of HBNC? The limitations of the approach, the settings where HBNC might be relevant and the management pre-requisites for its scaling up are also discussed. The need to develop an integrated approach is emphasized. A case for newborn care in the community is made for achieving equity in health care.

Perinatal Characteristics and Outcome of Neonates at NICU of a Tertiary Level Hospital in Bangladesh

“…These findings are similar to other studies of low resource countries. 1,[3][4][5]11,12 All these studies identified that malnutrition, lack of nutritional education and lack of early antenatal care are significant risk factors for low birth weight babies.…”

Causes of neonatal admissions and deaths at a rural hospital in KwaZulu-Natal, South Africa

“…gestational age <32 weeks) and with very low birthweight (VLBW) (<1,500 g) have mortality rates of over 50% in many low-resource settings and are at a higher risk for long-term disabilities and impairments. [2][3][4] One of the Millennium Development Goals (MDG-4) is to reduce the child mortality (under 5 years) rate by two-thirds by the year 2015 from a base line in 1990. The World Health Organization estimates that a significant proportion (40%) of all under 5 deaths occur in the neonatal or perinatal (0 to 28 days of life) periods.…”

Improved neonatal survival after participatory learning and action with women’s groups: a prospective study in rural eastern India

“…The health activists help mothers access antenatal care, encourage delivery in a health-care institution, offer home-based neonatal care during the first 7 days of life and provide counselling on community health and nutrition through home visits and community meetings. 4,5 While these initiatives should help improve neonatal survival, achieving adequate and equitable coverage is difficult. 6,7 Recent evaluations found that the poorest mothers did not always receive payments under the Janani Suraksha Yojana, that institutional delivery was not necessarily synonymous with good obstetric care and that the Janani Suraksha Yojana had not yet resulted in a large reduction in neonatal mortality.…”