Effect of Community-Based Maternal and Newborn Interventions on Neonatal Morality in Rural Uttar Pradesh, India

IntroductionThe neonatal period is recognized as a brief, critical time that requires focused interventions to reach the Millennium Development Goal (MDG) of a two-thirds reduction in child mortality by 2015. In spite of decline in global under-five and infant mortality rates during the recent decades, newborn mortality rate has remained relatively high (1, 2). In India there are one million neonatal deaths every year, representing approximately a quarter of all global neonatal deaths (2, 3). Neonatal deaths account for about 38% of the annual 10.6 million child deaths recorded worldwide and nearly half of the deaths in children under 5 years in India (1, 2). Two-thirds of infant deaths in India occur in the first month of life, and three-fourths of newborn deaths occur in the first week of life (1). Two-thirds of all births and three-fourths of births in rural areas of India take place at home. Untrained providers attend nearly 60% of all births (1).Most neonatal deaths in developing countries are associated with prematurity, maternal neglect and also complications of pregnancy, delivery and the postnatal period (4-6) and the majority of these deaths are thought to be preventable through standard antenatal, intrapartum and postnatal care (7) and mother's knowledge about pregnancy complications, delivery complications, postpartum complications and essential newborn care practices. Care practices immediately following delivery contribute to newborns' risk of morbidity and mortality (5,7-9). Knowledge about newborn care practices comprises of cutting and tying the umbilical cord aseptically, drying and wrapping the newborn promptly to prevent hypothermia, breastfeeding and seeking care immediately for signs of serious newborn illnesses. Clean cord care, thermal care and breastfeeding have been identified as proven interventions that save newborn lives (6-7, 9-11). However, few community-based studies have examined these care practices and their association with neonatal mortality and also community-based data from developing countries are scarce (12-15).Research conducted in low and middle income countries (LMICs) suggest that high coverage of a few simple and cost-effective interventions would reduce neonatal mortality (7, 16-18). Interventions at the family and community level can save lives, especially where health systems are weak (19, 7). Several community-based efficacy trials have evaluated service delivery strategies to improve newborn survival (11, 15, 20). However, population-level data on the impact of mother's knowledge of pregnancy, delivery, postpartum and new born complications and family and community-based neonatal care on neonatal mortality from large-scale programme is scarce.Here, we examined the effect of a community-based maternal and newborn interventions on neonatal morality in rural Uttar Pradesh, India.MethodsThis study used data from a large cross-sectional household survey conducted between January and March 2006 to evaluate a community-based intervention program known as the Integrated Nutrition and Health Programme (INHP) in two rural districts of the state of Uttar Pradesh (UP) in India. A quasi-experimental design was used and the study design, data collection and analysis were conducted by a team of independent researchers who were not involved in the implementation of the intervention. One INHP district namely Barabanki (UP), served as the intervention district, while a district receiving standard government health and Integrated Child Development Services (ICDS), Unnao, was used as a comparison district. From the 15 rural blocks in each district, we used a computer program to randomly select nine blocks in the intervention district and eight blocks in the comparison district (the difference in the number of blocks selected was due to differences in population size of the blocks in Barabanki and Unnao). One sector, an area with 15-25 Anganwadi workers (village-based workers) and an estimated population of 20000 to 25000 people, was randomly selected from each of the selected blocks. …