Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India

Abstract

Objective To assess the impact of the newborn health component of a large-scale community-based integrated nutrition and health programme. Methods Using a quasi-experimental design, we evaluated a programme facilitated by a nongovernmental organization that was implemented by the Indian government within existing infrastructure in two rural districts of Uttar Pradesh, northern India. Mothers who had given birth in the 2 years preceding the surveys were interviewed during the baseline (n = 14 952) and endline (n = 13 826) surveys. The primary outcome measure was reduction of neonatal mortality. Findings In the intervention district, the frequency of home visits by community-based workers increased during both antenatal (from 16% to 56%) and postnatal (from 3% to 39%) periods, as did frequency of maternal and newborn care practices. In the comparison district, no improvement in home visits was observed and the only notable behaviour change was that women had saved money for emergency medical treatment. Neonatal mortality rates remained unchanged in both districts when only an antenatal visit was received. However, neonates who received a postnatal home visit within 28 days of birth had 34% lower neonatal mortality (35.7 deaths per 1000 live births, 95% confidence interval, CI: 29.2-42.1) than those who received no postnatal visit (53.8 deaths per 1000 live births, 95% CI: 48.9-58.8), after adjusting for sociodemographic variables. Three-quarters of the mortality reduction was seen in those who were visited within the first 3 days after birth. The effect on mortality remained statistically significant when excluding babies who died on the day of birth. Conclusion The limited programme coverage did not enable an effect on neonatal mortality to be observed at the population level. A reduction in neonatal mortality rates in those receiving postnatal home visits shows potential for the programme to have an effect on neonatal deaths.

Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review

“…[18][19][20][21]30 The funnel plot appeared symmetrical, which suggests the absence of publication bias. This was confirmed using Egger's method (P = 0.…”

“…Five trials provided neonatal mortality data [18][19][20][21]30 and three provided data on stillbirths. [19][20][21] One trial provided infant mortality data and cause-specific mortality data.…”

“…Sylhet 18 and Shivgarh 20 trials were cluster-randomized and provided cluster-adjusted mortality data. The other three trials, from Hala, 19 Gadchiroli 21 and Barabanki, 30 were nonrandomized or quasi-randomized and had a concurrent control group. End-line evaluation provided data on 17 675 and 14 251 live births, and on 746 and 779 neonatal deaths in the intervention and control arms, respectively.…”

“…The remaining 13 references, which pertained to 5 trials, were included in the review. [18][19][20][21][22][23][24][25][26][27][28][29][30] Trial characteristics Table 2 summarizes the characteristics of included trials, all of which were conducted in southern Asian countries with high baseline neonatal mortality rates (> 45 deaths per 1000 live births). Sylhet 18 and Shivgarh 20 trials were cluster-randomized and provided cluster-adjusted mortality data.…”

Causes of neonatal death and associated health seeking behaviour in Barpeta district, Assam, India: a community based study

“…Home visit by trained health worker is an important intervention to prevent neonatal death and needs to be done under IMNCI and NSSK of RCH program. 23 In the present study 77.8% neonates were visited at least once at home by ASHA/ANM. Visits were erratic and not as per guideline.…”