Community Based Newborn Care: A Systematic Review and Meta-analysis of Evidence: UNICEF-PHFI Series on Newborn and Child Health, India.
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Date
2011-06
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Abstract
Background: The neonatal mortality rate (NMR) in India has remained virtually unchanged in the last 5 years. To achieve
the Millennium Development Goal (MDG) 4 on child mortality (two thirds reduction from 1990 to 2015), it is essential to
reduce NMR. A systematic review of the evidence on community-based intervention packages to reduce NMR is essential
for advocacy and action to reach MDG-4.
Objective: To assess the effect of community based neonatal care by community health workers (CHWs) on NMR in
resource-limited settings.
Design: Systematic review and meta-analysis of controlled trials.
Data sources: Electronic databases and hand search of reviews, and abstracts and proceedings of conferences.
Results: A total of 13 controlled trials involving about 192000 births were included in this systematic review. Community
based neonatal care by CHWs was associated with reduced neonatal mortality in resource-limited settings [RR=0.73
(0.65 to 0.83); P<0.0001]. The identified studies were a heterogeneous mix with respect to the extent and quality of
community based neonatal care provided and the characteristics of the CHWs delivering the intervention. There was no
consistent effect of training duration of the health workers, type of intervention (home visitation versus community
participatory action and learning), number of home visits done by CHWs, and provision of only preventive versus both
preventive and therapeutic care. Limited data suggests that the ideal time for the first postnatal visit is the first two days of
life. The interventions are highly effective when baseline NMR is above 50/1000 live births [RR=0.64(0.54 to 0.77)]. The
interventions show a significant decrease in efficacy as the NMR drops below 50/1000 live births [RR=0.85 (0.73 to 0.99)],
however is still substantial. NMR gains from home visitation approach are going to materialize only in the presence of high
program coverage of 50% or more.
Conclusion: A significant decrease in NMR is possible by providing community based neonatal care in areas with high
NMR by community health workers with a modest training duration and ensuring high program coverage with home
visitation on the first two days of life.
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Keywords
Action, Advocacy, Newborn, Child health, Community, Systematic reviews
Citation
Gogia Siddhartha,Ramji Siddarth, Gupta Piyush, Gera Tarun, Shah Dheeraj, Mathew Joseph L, Mohan Pavitra, Panda Rajmohan. Community Based Newborn Care: A Systematic Review and Meta-analysis of Evidence: UNICEF-PHFI Series on Newborn and Child Health, India.Indian Pediatrics. 2011 July; 48(7): 537-546.