A Dramatically Effective Save the Children Study Proves Newborn Mortality Can Be Cut by One-third.
A recent study cofunded by Save the Children reinforces the evidence that implementing a cost-effective, home-based health care strategy can cut newborn mortality by a third, even in the most underserved communities. The study was published in the The Lancet medical journal and was one of the winners of the prestigious Paper of the Year award in 2008.
|A mother and her 7-day-old child receive a home visit.
"We need to adopt and implement this intervention in the poor communities of Asia and Africa without losing effectiveness and that will save millions of lives,” study author Dr. Abdullah Baqui said. Four million newborn deaths – 99 percent of which are in developing countries – occur each year, mostly from preventable causes.
The Projahnmo (Project for Advancing the Health of Newborns and Mothers) study, supported by Save the Children and USAID, sought to determine the most effective and locally feasible way of providing care to mothers and newborns in rural Sylhet, Bangladesh, where newborn mortality is comparatively high and most births take place at home, without a skilled birth attendant.
Researchers compared three strategies for delivering care. In the first model local female health workers provided birth preparedness and newborn care techniques to pregnant women and new mothers at home, and treated newborn infections. In the second strategy, community health workers disseminated information on birth preparedness and newborn care at community meetings but they did not make home visits during pregnancy or after birth. Researchers then compared both of these models to the existing health-delivery system in Sylhet,
Hundreds Saved in Bangladesh, Potentially Millions Worldwide
The home-based care strategy resulted in a one-third (34 percent) reduction in newborn mortality in study areas. David Oot, Associate Vice-President of the Department of Health and Nutrition at Save the Children commented, "This study demonstrated that a package of basic, low-cost services and education, delivered through community health workers and the active engagement of other community members, can save newborn lives, and improve the lives of thousands of families."
For the home-based care strategy Health workers were recruited locally and received six weeks of training before visiting families in their districts. They made two home visits to expectant mothers, where they emphasized the importance of:
- Taking prenatal vitamins and folic acid
- Selecting a clean place for the mothers to give birth
- Using a sterile blade to cut the baby's umbilical cord
- Breastfeeding immediately after birth
- Keeping the newborn warm
They also advised new mothers and familes to seek appropriate care for signs of maternal and newborn illnesses, delay bathing the infant to avoid hypothermia and continue breastfeeding exclusively.
Families in the home-based care group also received three follow-up visits after the birth, on days 1, 3 and 7, when health workers were able to assess the health of the newborn, identify infants who were ill, provide initial treatment of infections and refer families to hospitals or complete the course of antibiotics for families opting for home-based treatment.
Dr. Uzma Syed, Asia Regional Advisor for Newborn Health at Save the Children's Saving Newborn Lives program, said, "The evidence collected here will help us tailor our work in Bangladesh and around the world, making it possible to help many more families."
Part II: A Sustainable, Cost-effective Approach
The average cost of providing home-based treatment per family in the Projahnmo study was U.S. $1, compared to U.S. $11 for care in a health facility – putting health care
The study was cosponsored by Save the Children and USAID.
within the reach of many more families in Bangladesh. For families in this rural district simply traveling to a clinic to get access to antibiotics is difficult, even when they can afford to buy them. Visiting health workers were able to provide drugs immediately, before a newborn's condition required hospitalization.
The home-based health care workers were each responsible for around 4,000 people, a figure similar to the current Bangladesh primary health care worker-to-population ratio, putting this approach on a par with the current system.
The cost per death averted of Save the Children's home-based approach was $3,000 less than a comparable study in Nepal, making it a realistic strategy for expanding health care programs without straining precious resources. Said David Oot, "Save the Children is working with policy makers to implement the home-based care model to reach more babies through national programs."
Save the Children has worked in Bangladesh since 1972, and because of the generosity of our donors roughly one-third of the population benefits from Save the Children programs.
Last updated January 2009