A homecare birth strategy is better than either a community strategy or the status quo at reducing neonatal mortality in communities with weak health systems. These are the conclusions of authors of an Article in this week's edition of the Lancet.
Dr Abdullah Baqui, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, and colleagues did a randomised controlled trial in the Sylhet district of Bangladesh, consisting of 24 clusters of married women aged 15-49, with each cluster containing around 20000 people. Eight clusters were assigned to each of the home-care, the community-care, and the control arms. In the home-care arm, female community health workers (1 per 4000 population) made two antenatal home visits to coach pregnant women on birth and newborn care practice, and also made postnatal visits to assess newborns on the first, third, and seventh days of birth, and referred or treated sick children. In the community care arm, both antenatal and postnatal care were promoted solely through group sessions held by female and male community workers. The primary outcome was reduction in neonatal mortality.
The number of participants was 36059, 40159, and 37598 in the home-care, community-care, and control arms, respectively, with 14769, 16325, and 15350 livebirths, respectively. In the last six months of the 30-month intervention, neonatal mortality rates were 29.2 per 1000, 45.2 per 1000, and 43.5 per 1000 in the home-care, community-care, and control arms, respectively. Thus neonatal mortality was reduced by 34% in the home-care arm compared with the control arm; but no mortality reduction was seen in the community-care arm compared with the control arm. A detailed analysis showed that the home-care strategy was cost effective, with the cost per neonatal death averted at US$2995.
The authors conclude: "A home-care strategy to promote an integrated package of preventive and curative newborn care is effective in reducing neonatal mortality in communities with a weak health system, low health-care use, and high neonatal mortality."
See also accompanying Comment
Dr Abdullah Baqui, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA T) +880-1715104048 (temporarily in Bangladesh) E) abaqui@jhsph.edu
http://multimedia.thelancet.com/pdf/press/bangladesh.pdf
Journal
The Lancet