Community-based behavior change management cuts neonatal mortality in half

September 25, 2008

A community-based program that reinforces basic childbirth and newborn care practices can reduce a baby's risk of death within the first month of life by as much as 54 percent, according to a study in rural India led by researchers at the Johns Hopkins Bloomberg School of Public Health in collaboration with CSM Medical University in Lucknow, India. The study is published in the September 27 issue of The Lancet.

"Changes in behavior such as preparing for the birth and skin-to-skin care to keep the baby warm, breastfeeding and infection prevention practices were found to significantly reduce neonatal mortality," said Gary Dramstadt, MD, the senior author and principal investigator of the study, who led the research while at the Bloomberg School of Public Health but is now Senior Program Officer for Neonatal Health with the Bill & Melinda Gates Foundation. "This was a unique experiment that tested a delivery model of preventive practices co-developed with community members. This was essentially a community-driven program that aimed to empower them to save the lives of their own babies," added Vishwajeet Kumar, MBBS, a researcher with the Bloomberg School's Department of International Health and first author and co-principal investigator of the study.

The randomized trial was conducted in Uttar Pradesh state, where 25 percent of India's 1 million annual neonate deaths occur. More than 80 percent of infant deliveries took place in the home and away from the formal health care system. As part of the study, the researchers worked with community members to develop simple, culturally relevant messages to reinforce healthy birth preparedness and clean delivery, hygienic umbilical cord care, skin-to-skin care (holding the baby close against the mother's chest), breastfeeding and keeping the baby warm.

Community health workers, with support from community volunteers, worked with pregnant women, their family members and key community members through a series of home visits and community meetings. The behavior change messages were incorporated by the community into traditional folk songs, which served to further promote the practices and change social norms.

Compared to a control group that received the basic governmental and nongovernmental organization services offered in the region, villages that received the intervention saw a 54 percent reduction in infant deaths during the first month following birth. A second group, which received the same intervention plus a liquid crystal hypothermia indicator to help monitor the baby's temperature, had a 52 percent reduction in neonatal deaths.

"This study adds to a growing body of evidence that community engagement to ensure the survival of newborns and acceptance of specific changes in care practices can substantially reduce mortality in the very vulnerable first month of life," said Robert Black, MD, coauthor of the study and chair for the Bloomberg School's Department of International Health.

"The study findings validate the ongoing efforts by USAID to reduce newborn mortality through community-based strategies where health workers provide essential newborn care and promote good family care practices during the postnatal period," said Kent Hill, assistant administrator for Global Health, U.S. Agency for International Development. "Even in settings where health systems are weak, we can improve dramatically the lives of newborns."
Other authors of "Effect of community-based behavior change management on neonatal mortality in Shivgrah, Uttar Pradesh, India: a cluster-randomised controlled trial" include Saroj Mohanty, Aarti Kumar, Mathuram Santosham, Shally Awasthi, Abdullah H. Baqui, Pramod Singh, Vivek Singh, Ramesh C. Ahuja, Jai Vir Singh, Gyanendra Kumar Malik, Saifuddin Ahmed and Mahendra Bhandari.

Funding was provided by USAID and Save the Children-USA through a grant from the Bill & Melinda Gates Foundation.

Johns Hopkins University Bloomberg School of Public Health

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