Training Existing Health Workers Could Save 100,000 Newborns a Year in Pakistan Alone
A new study of training Pakistan’s “lady health workers” offers great hope for saving newborn lives. Photo credit: Alixandra Fazzina/Save the Children
Tanya Weinberg 202.640.6647 (W), 202.247.6610 (M)
WESTPORT, Conn. (January 14, 2011) — A Pakistan-based study to be published Saturday in the Lancet medical journal achieved a significant drop in newborn deaths and could be widely applicable in high-mortality countries around the world, its authors said.
More than 3 million newborns die each year from largely preventable causes. Well-known lifesaving interventions continue to be out of reach for the majority of mothers and newborns in the developing world.
The research trial required no new technology and relied solely on introducing counseling and educational outreach on proven newborn health practices into Pakistan’s public health system in the rural district of Hala. As a result, newborn mortality and stillbirths there dropped 15-20 percent, more mothers gave birth in facilities and newborn care practices improved substantially. The 2-year research trial ran from 2006-08 and differed from previous newborn care studies because researchers worked through a large public sector program and hired no new health workers.
Training Existing Health Workers Reduces Newborn Mortality, is Sustainable
“This study shows, for the first time, how proven newborn health interventions can be integrated effectively into an existing public health system. That means these kind of lifesaving results are feasible and sustainable.” said Dr. Zulfiqar A. Bhutta, lead author of the Lancet article and professor and chair of women and child health at Aga Khan University in Karachi, Pakistan.
The Hala study tested the introduction of newborn care practices by giving additional training to members of Pakistan’s corps of community health workers. These “lady health workers” of the National Program for Family Planning and Primary Care often have no more than a 10th grade education. The government trains them to focus primarily on family planning and general health care, although they are also trained to visit pregnant women at home to promote postnatal care and some aspects of immediate newborn care.
Researchers in the Hala study trained lady health workers to also provide group counseling on maternal and newborn care practices, to partner with traditional birth attendants, and to make home visits to teach simple newborn care practices to new mothers. These included early and exclusive breastfeeding, delayed bathing and early recognition of signs of serious newborn illness.
Simple Measures Could Save 100,000 Pakistani Newborns a Year
“In Pakistan alone, nationalizing these simple measures could save 100,000 lives a year — and potentially more with wider coverage than what was achieved in the study area,” Dr. Bhutta said. “Far greater numbers of babies could be saved globally. Large countries with high newborn mortality — such as India and Ethiopia —have similar cadres of community health workers that could adopt these methods.”
While under-5 mortality has declined substantially in recent decades, reductions in newborn mortality have been slow. Newborn deaths now constitute more than 40 percent percent of the 8.1 million child deaths annually.
Groundbreaking Results Mean Major Advances Possible Quickly
Charles MacCormack, President and CEO of Save the Children called the Hala study results “groundbreaking.”
“A growing proportion of child deaths occur in the first month of life. This study’s remarkably hopeful finding shows it doesn’t have to be this way,” MacCormack said. “We urge governments and their partners to adopt this low-tech, high-impact strategy. It can save large numbers of newborn lives, and do so quickly.”
In the Hala trial, lifesaving newborn care practices improved significantly when families received the strengthened package of newborn care. Sixty percent more mothers breastfed their newborns within one hour of birth, and 36 percent more mothers gave the antibody-rich first breast milk, called colostrum, which is often traditionally discarded.
Although the number of mothers and their newborns receiving a postnatal visit from a lady health worker at the end of the study was relatively small (28 percent), it represented a nearly three-fold increase from the start of the study (8 percent).
WHO Recommends Broad Application of Study Methods
"This trial proves that trained community health workers can effectively deliver essential newborn care. This type of training can and should be scaled up within public sector programs to save newborn lives," said Dr Elizabeth Mason, Director of the World Health Organization’s Department of Maternal, Newborn, Child and Adolescent Health.
The Hala trial was funded by grants from the World Health Organization and Save the Children’s Saving Newborn Lives program, funded by the Bill & Melinda Gates Foundation.
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