Home-Based Care Significantly Reduces Neonatal Mortality in Developing Countries

A new study from Bangladesh published today in The Lancet shows that a home-care strategy reduced neonatal mortality by 34 percent.  This study adds to the growing body of evidence that home- and community-based strategies can significantly reduce neonatal mortality by improving newborn care including identification and management of newborns illnesses outside of a health-care facility.  For the 60 million children born each year without a trained birth attendant, community-based prevention, identification of sick newborns, and care strategies are necessary to reduce mortality within the first month of life.

Through public-private partnership, community health workers (CHWs) were trained to promote a package of antenatal and postpartum interventions during home visits in rural areas with high neonatal mortality rates. The study team, also known as Projahnmo (generation), evaluated the impact of the intervention using a cluster-randomized controlled trial design. The encouraging findings are particularly relevant where health systems are strained, neonatal mortality is high, and access to care is low.
 
“We are excited by the results of this study, which documents that community health workers—individuals with limited education and training—can help reduce neonatal mortality by teaching families proper neonatal care and working with them to manage life threatening illness,” said Dr. Kent R. Hill, Assistant Administrator for Global Health at the U.S. Agency for International Development (USAID), which co-funded the study with Save the Children’s Saving Newborn Lives program through a grant from the Bill & Melinda Gates Foundation. The study was heralded in a companion Lancet editorial by Don Thea of Boston University and Shamim Qazi of the World Health Organization.  These experts noted that because this scientifically rigorous large study was implemented using existing PVO/NGO and government health service delivery programs, the findings have significant “generalizability and program relevance.”

Few proven strategies to improve newborn survival have successfully been taken to scale in low-resource settings.  This study effectively used government and NGO infrastructures to facilitate a sustainable home-care approach. As a part of the study, CHWs identified and managed newborns with infections using a simple diagnostic approach. Approximately one-third of the neonatal infection cases were successfully referred to health facilities for urgent care.  Through this new approach an additional group that might not have sought care was treated--42 percent of cases were treated with injectable antibiotics by CHWs. These positive outcomes build the evidence-base that serious illness can be managed capably in the community or home. David Oot, Associate Vice-President of the Office of Health at Save the Children/US, noted that “This study is a very significant contribution to the growing body of evidence that life-saving newborn care can be successfully delivered by community health workers—and that it can be done within the context of existing health systems in low-resource settings.”

“Based upon the study results, USAID’s mission, in partnership with the government of Bangladesh and our development partners, is implementing a large-scale community-based project to improve newborn health in rural areas of Bangladesh,” said Sheri-Nouane Johnson, Director, USAID/Bangladesh Office of Population, Health and Nutrition. A Bangladesh Ministry of Health and Family Welfare advisory committee on newborn care is actively considering how the neonatal sepsis management components of the Projahnmo project can be integrated into national programs. 

Although worldwide under-five mortality is declining, newborn mortality has not declined as rapidly, with an estimated 4 million annual neonatal deaths globally. Currently half of all births in developing countries occur at home, and poor care practices at home and access to care are significant barriers to reducing newborn mortality. Abdullah Baqui, the lead author, an associate professor at the Johns Hopkins Bloomberg School of Public Health and an adjunct scientist of ICDDR,B, is optimistic about the future of home-care strategies in developing countries, “Scaling up of this evidence-based intervention package could significantly improve access to essential and sick newborn care in developing countries, saving millions of newborn lives every year and taking pressure off of strained health care systems.”

The Projahnmo Study Group included researchers from the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), the Bangladesh Ministry of Health and Family Welfare, the Johns Hopkins Bloomberg School of Public Health, and non-governmental organizations in Bangladesh, including Shimantik, Dhaka Shishu Hospital, and the Institute of Child and Mother Health.