A significant drop in newborn deaths can be achieved through the public health system in Pakistan, says a new study published in the Lancet today, and the interventions could be widely applicable in countries around the world with high newborn mortalities.
The research trial was carried out by Aga Khan University’s Division of Women and Child Health in partnership with the Government of Pakistan’s Ministry of Health, the World Health Organization and Save the Children’s Saving Newborn Lives programme. It required no new technology and relied solely on introducing counselling and educational outreach on well-known lifesaving newborn health practices into the National Programme for Family Planning and Primary Care in Hala and Matiari in rural Sindh. It led to a 15-20 per cent drop in newborn deaths and stillbirths, more mothers giving birth in a health facility with access to medical assistance and newborn care practices improving substantially.
The two-year scale-up study ran from 2006-08 and differed from previous newborn care studies because it hired no new health workers. Instead it introduced a community-based intervention package, delivered through lady health workers (LHWs) from the national programme working with traditional birth attendants (dais) and community health committees.
“This study shows, for the first time, how proven newborn health interventions can be integrated effectively into an existing public health system, which means these kind of lifesaving results are feasible and sustainable,” said Dr Zulfiqar Bhutta, lead author of the Lancet article and Chair, Division of Women and Child Health at AKU.
Newborn deaths account for 57 per cent of deaths in children five years and younger in Pakistan which has one of the highest mortality rates in South Asia for children in this age group – 94 deaths per 1000 live births versus an average rate of 50-60 per 1000 live births in the region. There are also significant urban-rural differences: 48 newborn deaths per 1000 live births in urban areas versus 55 in rural, where more than half of the home births take place in the hands of dais.
Researchers in the Hala study provided additional training to LHWs. These community workers were taught how to provide group counselling on maternal and newborn care practices, to partner with the dais, and to make home visits to teach simple newborn care to new mothers, including early and exclusive breastfeeding, delayed bathing and early recognition of signs of serious newborn illnesses.
“In Pakistan alone, nationalising these simple measures could save close to 100,000 lives a year – and potentially more with wider coverage than what was achieved in the study area,” said Dr Bhutta, adding, “Far greater numbers of babies could be saved globally. Large countries with high newborn mortality – such as India and Ethiopia – have similar cadres of community health workers that could adopt these methods.”
In the Hala trial, lifesaving infant care practices improved significantly when families received the strengthened package of newborn care. As many as 60 per cent more mothers breastfed their infants within one hour of birth, and 36 per cent more mothers gave the antibody-rich first breast milk, called colostrum, which is often traditionally discarded. Also, the number of mothers and their newborns receiving a postnatal visit from a LHW registered a nearly three-fold increase, jumping to 28 per cent from a mere 8 per cent at the start of the study.
More than 3 million newborns die each year from largely preventable causes globally. “This trial proves that trained community health workers can effectively deliver essential newborn care. This type of training can and should be scaled up within public sector programmes to save newborn lives,” said Dr Elizabeth Mason, director of the World Health Organization’s Department of Maternal, Newborn, Child and Adolescent Health.
Charles MacCormack, President and CEO of Save the Children called the Hala study results “groundbreaking.” “A growing proportion of child deaths occur in the first month of life. This study’s remarkably hopeful finding shows it doesn’t have to be this way,” MacCormack said. “We urge governments and their partners to adopt this low-tech, high-impact strategy. It can save large numbers of newborn lives, and do so quickly.”
The Hala trial was funded by grants from the World Health Organization and Save the Children’s Saving Newborn Lives programme, funded by the Bill & Melinda Gates Foundation.