Abstract
OBJECTIVE:
We found a high burden of morbidities in a cohort of neonates observed in rural Gadchiroli, India. We hypothesised that interventions would reduce the incidence of neonatal morbidities, including the seasonal increase observed in many of them. This article reports the effect of home-based neonatal care on neonatal morbidities in the intervention arm of the field trial by comparing the early vs late periods, and the possible explanation for this effect.
METHODS:
During 3 years (1995 to 1998), trained village-health-workers (VHWs) in 39 villages prospectively collected data by making home visits during pregnancy, home-delivery and during neonatal period. We estimated the incidence and burden of neonatal morbidities over the 3 years from these data. In the first year, the VHWs made home visits only to observe. From the second year, they assisted mothers in neonatal care and managed the sick neonates at home. Health education of mothers and family members, individually and in group, was added in the third year. We measured the coverage of interventions over the 3 years and evaluated maternal knowledge and practices on 21 indicators in the third year. The effect on 17 morbidities was estimated by comparing the incidence in the first year with the third year.
RESULTS:
The VHWs observed 763 neonates in the first year, 685 in the second and 913 in the third year. The change in the percent incidence of morbidities was (i) infections, from 61.6 to 27.5 (−55%; p<0.001), (ii) care-related morbidities (asphyxia, hypothermia, feeding problems) from 48.2 to 26.3 (−45%; p<0.001); (iii) low birth weight from 41.9 to 35.2 (−16%; p<0.05); (iv) preterm birth and congenital anomalies remained unchanged. The mean number of morbidities/100 neonates in the 3 years was 228, 170 and 115 (a reduction of 49.6%; p<0.001). These reductions accompanied an increasing percent score of interventions during 3 years: 37.9, 58.4 and 81.3, thus showing a dose–response relationship. In the third year, the proportion of correct maternal knowledge was 78.7% and behaviours was 69.7%. The significant seasonal increase earlier observed in the incidence of five morbidities reduced in the third year.
CONCLUSION:
The home-based care and health education reduced the incidence and burden of neonatal morbidities by nearly half. The effect was broad, but was especially pronounced on infections, care-related morbidities and on the seasonal increase in morbidities.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Prices vary by article type
from$1.95
to$39.95
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Murrey CJ, Lopez AD . The global burden of disease. Summary. The World Health Organisation, World Bank and The Harvard School of Public Health. Geneva; 1996.
Save the Children. The State of the World's Newborn. Save the Children. Washington, DC; 2001.
World Health Organisation. World Health Report, 1998: Life in 21st Century — A Vision For All. WHO, Geneva; 1998.
Stoll BJ . The global impact of neonatal infection. Clin Perinatol 1997;24(1):1–21.
Bang AT, Bang RA, Baitule SB, Deshmukh MD, Reddy MH . Burden of morbidities and the unmet need for health care in rural neonates — a prospective observational study in Gadchiroli, India. Indian Pediatr 2001;38:952–965.
Bang AT, Bang RA, Morankar VP, et al. Pneumonia in neonates: can it be managed in the community? Arch Dis Child 1993;68:550–556.
Sutrisna B, Reingold A, Kresno S, et al. Care-seeking for fatal illness in young children in Indramayu, West Java, Indonesia. Lancet 1993;342:887–889.
Bang AT, Reddy HM, Baitule SB, et al. The incidence of morbidities in a cohort of neonates in rural Gadchiroli, India: seasonal & temporal variation & a hypothesis about prevention. J Perinatol 2005;25:S18–28.
Bang AT, Bang RA, Baitule SB, Deshmukh MD, Reddy MH . Effect of home based neonatal care and management of sepsis on neonatal mortality: field trial in rural Gadchiroli. Lancet 1999;354:1955–1961.
Bang AT, Bang RA, Tale O, et al. Reduction in pneumonia mortality and total childhood mortality by means of community-based intervention trial in Gadchiroli, India. Lancet 1990;336:201–206.
Bang R, Bang A . Commentary on a community-based approach to reproductive health care. Int J Gynecol Obstet 1989;3(Suppl):125–129.
Bang AT, Bang RA, Reddy HM, et al. Methods and the baseline situation in the field trial of home-based neonatal care in Gadchiroli, India. J Perinatol 2005;25:S11–S17.
Registrar General of India. The Report of the Sample Registration System, 1998, The Ministry of Home Affairs, Government of India, New Delhi, 2000.
WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality. Effect of breastfeeding on infant and child mortality due to infections in less developed countries: a pooled analysis. Lancet 2000;355:451–455.
John TJ, Bodhankar U . Birth attendants: one or two? Indian Pediatr 2001;38:327–331.
Standing H, Costello A . Social and developmental issues affecting the perinatal health of mothers and their infants In: Costello A, Manandhar D, editors Improving Newborn Infant Health in Developing Countries. London: Imperial College Press; 2000. p. 79–98.
Ceesay SM, Prentice AM, Cole TJ, et al. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: five-year randomised controlled trial. Br Med J 1997;315:786–790.
Bolam A, Tillen D, Costello A . Does health education improve newborn care? In: Costello A, Manandhar D. Improving Newborn Infant Health in Developing Countries. London: Imperial College Press; 2000. p. 393–408.
Bandura A . Self-efficacy: towards a unifying theory of behavioural change. Psychol Rev 1997;84:191–225.
Kumar R . Training of traditional birth attendants for resuscitation of newborns. Trop Doctor 1995;25:29–30.
Daga SR, Daga AS . Reduction in neonatal mortality with simple interventions. J Trop Pediatr 1989;35:191–195.
Kamal I . Traditional birth attendants' training: sharing experiences. Int J Obset Gynecol 1992;38(Suppl):S55–58.
Bergman NJ, Jurisoo LA . The ‘kangaroo method’ for treating low birth weight babies in a developing country. Trop Doctor 1994;24:57–60.
Narayanan I, Prakash K, Murthy NS, Gujral VV . Randomised controlled trial of effect of raw and holder pasteurised human milk and of formula supplements on incidence of neonatal infections. Lancet 1984;2:1111–1113.
Victora CG, Vaughan JP, Lombardic, et al. Evidence for protection by breast-feeding against infant deaths from infectious diseases in Brazil. Lancet 1987;2:319–322.
Hammerschlag MR, Cummings C, Robin PM, Williams TH, Delke I . Efficacy of neonatal ocular prophylaxis for prevention of chlamydial and gonococcal conjunctivitis. N Engl J Med 1989;320:769–772.
Manandhar D, Osrin D, Shreshtha BP, et al. Effect of a participatory intervention with women's groups on birth outcome in Nepal: cluster-randomized controlled trial. Lancet 2004;364:970–979.
Bang AT, Reddy HM, Deshmukh MD, et al. Effect of home-based neonatal care on neonatal and infant mortality (1993–2003). J Perinatol 2005;25:S92–107.
Author information
Authors and Affiliations
Corresponding author
Additional information
This work was financially supported by The John D. Catherine T. MacArthur Foundation, The Ford Foundation, Saving Newborn Lives, Save the Children, USA, The Bill and Melinda Gates Foundation and The Rockfeller Foundation.
Rights and permissions
About this article
Cite this article
Bang, A., Bang, R., Reddy, H. et al. Reduced Incidence of Neonatal Morbidities: Effect of Home-Based Neonatal Care in Rural Gadchiroli, India. J Perinatol 25 (Suppl 1), S51–S61 (2005). https://doi.org/10.1038/sj.jp.7211274
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.jp.7211274
This article is cited by
-
Training programs to improve identification of sick newborns and care-seeking from a health facility in low- and middle-income countries: a scoping review
BMC Pregnancy and Childbirth (2021)
-
Community health workers at the dawn of a new era: 6. Recruitment, training, and continuing education
Health Research Policy and Systems (2021)
-
Surmounting difficulties to provide home based neonatal care – reflections of community health workers
BMC Women's Health (2018)
-
Care of newborn in the community and at home
Journal of Perinatology (2016)
-
Home-based neonatal care by community health workers for preventing mortality in neonates in low- and middle-income countries: a systematic review
Journal of Perinatology (2016)