Community-based behavior-change management lowers neonatal mortality in poor settings

September 25, 2008

A preventive package of interventions such as birth preparedness, clean delivery and cord care, thermal care (including skin-to-skin care), and breastfeeding promotion can reduce neonatal mortality in poor countries where many births take place at home and high-risk practices are common. These are the conclusions of an article in this week's edition of The Lancet, written by Dr Gary Darmstadt, Johns Hopkins Bloomberg School of Public Health, USA, and Dr Vishwajeet Kumar, Johns Hopkins and CSM Medical University, Lucknow, India, and colleagues.

In this randomised controlled trial in Shivgarh, India, 39 village units (total population 104 123) were allocated to one of three groups - conventional government and non-government organisation services in their area; an intervention group which received a package of interventions as listed above; and another intervention group, which received the same intervention package plus use of a liquid crystal hypothermia indicator. The intervention groups received these packages via community meetings plus two antenatal and two postnatal household visits, thus targeting multiple influencers and providers of newborn care. The researchers found the neonatal mortality rate was reduced by 54% in the first intervention group and by 52% in the intervention plus hypothermia indicator group.

The authors conclude: "A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification, shifts in social norms and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build capacity for sustained development."

In an accompanying comment, Professor Zulfiqar A Bhutta and Dr Sajid Soofi, Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan, say: "We know enough about what works to implement preventive community-based strategies to improve maternal and newborn health by 2015. The crucial issue is whether political will and the policy framework for implementing these interventions at scale exist."
Dr. Vishwajeet Kumar, CSM Medical University, Lucknow, India T) +919935689777, E)

Dr Gary Darmstadt, current address: Bill & Melinda Gates Foundation, Seattle, WA, USA T) +1 443-858-9110 E)

Professor Zulfiqar A Bhutta, Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan T) +92-300-8236813 E)

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