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Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India

Article from the Lancet 1999.  The findings may be relevant today:

Village health workers trained in neonatal care made home visits and managed birth asphyxia, premature birth or low birthweight, hypothermia, and breast-feeding problems. They diagnosed and treated neonatal sepsis. Assistance by trained traditional birth attendants, health education, and fortnightly supervisory visits were also provided. Other workers recorded all births and deaths in the intervention and the control area (1993-98) to estimate mortality rates.

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Home-based neonatal care, including management of sepsis, is acceptable, feasible, and reduced neonatal and infant mortality by nearly 50% among our malnourished, illiterate, rural study population. Our approach could reduce neonatal mortality substantially in developing countries.

Training Needed for Midwives and Attendants to Lower Infant Mortality

Women need trained help during labor and delivery.   Everyone agrees to this.  This article http://www.nichd.nih.gov/news/resources/spotlight/111810-saving-infant-lives.cfm highlights two studies that reveal the need to train those helping women during birth in “resuscitation, daily hygiene, how to keep infants warm, early and exclusive breastfeeding, “kangaroo” (skin-to-skin) care, and ways to recognize and address signs of infant distress and health complications.”

The study, conducted through the Global Network for Women’s and Children’s Health Research, which is funded by the NICHD and other sources, showed that training birth care providers on the basics of caring for infants and in resuscitation reduced neonatal mortality by 40 percent. The results of the study appeared in the October 13 issue of Pediatrics.

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To address the major causes of infant death during the first seven days after birth—birth asphyxia, low birth weight and problems from preterm birth, and infections—in developing countries, the WHO created a program called Essential Newborn Care (ENC). ENC is designed to set minimum infant care standards for resource-poor countries and to educate and train midwives and birth care providers on evidence-based guidelines for newborn care. In addition, the Global Network created a neonatal resuscitation program as a way to reduce deaths specifically from birth asphyxia and tested the program in a large-scale trial called First Breath.

The recent study, conducted in 18 low-risk health centers in Zambia, Africa, implemented a “train-the-trainer” model in which midwives and other birth workers received a five-day course in ENC and the Global Network’s neonatal resuscitation program. The training included basic infant care techniques such as resuscitation, daily hygiene, how to keep infants warm, early and exclusive breastfeeding, “kangaroo” (skin-to-skin) care, and ways to recognize and address signs of infant distress and health complications. Research staff taught local health care workers how to collect data and assess infant health before data collection on births began. In all, the study followed more than 70,000 births.

The research showed that these low-cost interventions were effective in decreasing death rates from the major causes of death. The results showed that after staff received the training, the infant death rate during the first seven days after birth dropped from 11.5 deaths for each 1,000 births to 6.8 deaths per 1,000 births. In addition, deaths attributed to birth asphyxia were also reduced.

“The findings provide the best evidence yet that these two low-cost training programs, whether used in a community or clinic setting, are effective in combating infant mortality in the developing world, ” said Waldemar A. Carlo, M.D., from the University of Alabama at Birmingham. Dr. Carlo led the research team along with Linda L. Wright, M.D., scientific director of the NICHD Global Network for Women’s and Children’s Health Research, and others.

Another recent study from the same team of researchers in the Global Network for Women’s and Children’s Health Research supported the findings of the train-the-trainer model for reducing stillbirth. They found that a basic three-day ENC training program reduced the rate of stillbirths in rural areas of six resource-poor countries by more than 30 percent. This study, which was published in the February, 2010, issue of The New England Journal of Medicine, tracked more than 120,000 births at health centers in Argentina, the Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia.

Ready to Bring Clean Birth Kits for Laos

I am actively looking now for an organization/hospital in Laos that would like free clean birth kits, as well as training for their pre-exisiting staff.  Articles like the one that follows about Xekong province in Laos makes me want to get started NOW.

While the Millennium Development Goals aim for 260 maternal deaths out of every 100,000 births by 2015 currently this province has 406 per 100,000 births and infant mortality stands at 48 per 1,000 births. In the under five age group the mortality rate is now 65 per 1,000 children. UGH!

I understand that clean birth kits are not enough to solve the problem but they can address sepsis and improve birth outcomes.

Here is the article:

High maternal, child mortality rate persists in Xekong

The maternal and child mortality rate in Xekong province is likely to still be high by the year 2015, Xekong provincial Health Department Director Mr Visan Inthavong said on Thursday.

This is one of many challenges facing the Xekong authorities as the province tries to achieve the United Nations’ Millennium Development Goals (MDGs) by 2015, and will be a priority from now until then.

“The maternal mortality rate in Xekong province is now 406 per 100,000 births and infant mortality stands at 48 per 1,000 births. In the under five age group the mortality rate is now 65 per 1,000 children. The MDG target is to reduce the death rate of birthing mothers to 260 out of every 100,000 births by 2015. But I don’t think Xekong province can achieve this goal,” Mr Visan said.

In 2015, we estimate that the maternal mortality rate in Xekong will be 310 per 100,000 births, the infant mortality rate will remain at 1 percent, and among under fives it will drop to 53 percent, Mr Visan said.

In other areas, 64 percent of people in the province have access to clean drinking water but 70 percent don’t have a hygienic toilet they can use on a daily basis.

Last year, more than 27,000 people received health check-ups at hospitals and dispensaries, which is an increase from previous years.

Mr Visan said the healthcare network covers 98 percent of the province with a provincial hospital, three district hospitals, 16 dispensaries and 27 private pharmacies.

However, these facilities are not enough to meet the needs of the province as it develops and Xekong requires more medical staff, health facilities and modern equipment in the near future to achieve the MDGs and lower the maternal and child mortality rate by 2015.

“To reduce the maternal and child mortality rate by 2015 we have implemented a number of initiatives. These include a project to provide free treatment to children under five years old and a free health service for mothers and children. More low-income families now have access to our services throughout the province,” Mr Visan said.

Xekong province hopes to build a new 120-bed hospital with modern medical equipment, and new dispensaries for people living in remote areas that are inaccessible by road.

Xekong is the poorest province in Laos and is home to more than 100,000 people, of whom 90 percent live in rural areas. There are four districts: Kaleum, Lamam, Dakcheung, and Thataeng. Dakcheung and Kaleum are on the government’s list of the 45 poorest districts in the country.

Source: Vientiane Times
(Latest Update October 29, 2011)

Swiss doctors help Lao newborns survive

Article in Lao Voices about Lao baby docs getting a skills update:

Health officials are confident of a significant reduction in neonatal death rates now that the Swiss-Laos Hospital Project has updated the skills of Lao neonatologists nationwide.

This was the first opportunit y for many Lao neonatologists to share their experiences with skilled Swiss experts from the project, which aims to help Laos reach the United Nations Millennium Development Goals (MDGs) on reducing the death rates of mothers and children by 2015.

Dr Marion Monkhoff (second right) explains the care of newborns, witnessed by Dr Bouavanh Saensathit ( fourth right ) and Swiss neonatologists.

The specific targets agreed by the Ministry of Health under the MDGs are to reduce the death rate of birthing mothers to 260 out of every 100,000 births by 2015. Most recent statistics put this figure at 300 in 2010.

The other target is for a reduction in the death rate of children under one year old from 55 (2010) down to 45 (by 2015) out of every 1,000, and for children under five a reduction from 75 (2010) to 70 (by 2015) out of every 1,000.

Vice President of the Swiss-Laos Hospital Project, Dr Marion Monkhoff, said on Friday the project was very pleased to join the Lao Ministry of Health in working to achieve MDG 4 on reducing the death rate of infants and MDG 5 on the improvement of maternal health.

“The project aims to help all newborns to survive with good health,” she said.

During the three-day training course, Lao and Swiss neonatologists not only covered modern theory of neonatal and midwifery procedures, but also the practical field to make sure they can help newborns in the best way possible.

After the training course, the project provided participants with essential equipment for the care of newborns. Participants will return to their hometowns to pass on their skills to newly-qualified colleagues, thus further ensuring Laos achieves its MDGs in relation to mother and child health.

Director of the Mother and Child Health Hospital, Associate Prof. Dr Bouavanh Saensathit, said that continuous improvement and training of provincial neonatologists was the correct way to proceed, in light of maternal and infant mortality rates remaining stubbornly high in some rural areas.

“The Swiss assistance supports the Ministry of Health’s policy to lower the mortality rate of mothers and children throughout the country,” he said. The financial contribution provided by the Swiss-Laos Hospital Project varies between US$0.5 million and US$1 million per annum. It is envisaged that the project will continue to help Laos for many years to come.

The Swiss-Laos Hospital Project is an initiative by Swiss doctors, midwives, nurses and project participants, who have worked for improvements in the medical care available to mothers and children in Laos since 2000.

Source: Vientiane Times
By Xayxana Leukai
(Latest Update March 20, 2012)

Study: An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan

A study  in the New England Journal of Medicine shows that use of clean birth kits by birth attendants, in conjunction with to antenatal visits, effectively reduced perinatal mortality in Pakistan.

Background.  There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries.
Me thods.  We performed a cluster-randomized, controlled trial involving seven subdistricts (talukas) of a rural district in Pakistan. In three talukas randomly assigned to the intervention group, traditional birth attendants were trained and issued disposable delivery kits; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes; and obstetrical teams provided outreach
clinics for antenatal care. Women in the four control talukas received usual care. The primary outcome measures were perinatal and maternal mortality.

Conclus ions

Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality. This model could result in large improvements in perinatal and maternal health in developing countries.

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