Newborn-Care Training and Perinatal Mortality in Developing Countries

Abstract

Background Ninety-eight percent of the 3.7 million neonatal deaths and 3.3 million stillbirths per year occur in developing countries, and evaluation of community-based interventions is needed. Methods Using a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of the small baby, and common illnesses), and in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (in depth basic resuscitation), except in Argentina. The Essential Newborn Care intervention was assessed with a before and after design (N=57, 643). The Neonatal Resuscitation Program intervention was assessed as a cluster randomized controlled trial (N=62,366). The primary outcome was 7-day neonatal mortality. Results The 7-day follow-up rate was 99.2%. Following Essential Newborn Care training, there was no significant reduction from baseline in all-cause 7-day neonatal (RR 0.99; CI 0.81, 1.22) or perinatal mortality; there was a significant reduction in the stillbirth rate (RR 0.69; CI 0.54, 0.88; p<0.01). Seven-day neonatal mortality, stillbirth, and perinatal mortality were not reduced in clusters randomized to Neonatal Resuscitation Program training as compared with control clusters. Conclusions Seven-day neonatal mortality did not decrease following the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced following this intervention. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates. (clinicaltrials.gov number, NCT00136708).

Óbito neonatal precoce e tardio: perfil das mães e dos recém-nascidos

“…In Cuiabá, in 2010, neonatal deaths accounted for more than 60% of infant deaths, which is very significant and reproduces the national data from 2009 (10) and is also similar to findings in developed countries such as Canada (58%) (11) . However, in poor countries of Africa, neonatal deaths account for slightly more than 30% of infant mortality, in view of the unfavorable living and health conditions of the population that elevate post-neonatal mortality (11) .…”

Stillbirths: what difference can we make and at what cost?

“…95,96 However, a high proportion of the eff ect of such community platforms, including women's support groups, 104 is through preventive care and improved care seeking rather than from direct domiciliary care for maternal and neonatal complications. Indeed, community-based trials of training community health workers and traditional birth attendants in neonatal resuscitation 93,105,106 and care of neonates with very low birthweight 28 have underscored the limitations of training for such care providers. Hence, wherever deployed and feasible, outreach workers should be linked to functional facilities.…”

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

“…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.…”