Introduction: Using research for improved delivery of newborn health interventions

Abstract

Community-based delivery of interventions for newborn health may prevent over one million neonatal deaths every year if universal coverage is achieved. A core element of newborn health programs is the promotion of optimal newborn care practices at home. Designing program strategies to achieve high intervention coverage and effectiveness requires site-specific information on existing practices, barriers and facilitating factors for adopting optimal practices, as well as identifying key decision makers in the family, and the channels through which the intervention can reach them. Although this information is often collected through formative research for the development and evaluation of interventions in the context of research studies, it is not usually available to maternal and child health programs. Furthermore, formative research findings are often unpublishedFor only provided in brief as part of papers reporting the results of evaluation of interventions. Information on the formative data gathering process and on the practices they explore is often relegated to unpublished reports. This information, however, would be highly valuable when planning for intervention development in the programmatic context. The World Health Organization organized a workshop on formative research for newborn health interventions in Udaipur, India, in April 2006. The workshop aimed to bring together formative research experiences and data from recently completed and ongoing studies to evaluate newborn health interventions. The workshop was attended by investigators from nine studies funded by the Saving Newborn Lives Programme of Save the Children (USA), Department for International Development (UK) and the World Health Organization in South Asia and Africa. Each group of investigators presented the methods and results of formative research in their study. Although all the studies were aimed at improving newborn health and survival, they targeted different maternal and newborn care practices. Studies focused on antenatal care, birth preparedness, childbirth practices, early initiation of breastfeeding, umbilical cord care, low-birth-weight care and care seeking for neonatal illness. The study from Nepal focused on the development of an intervention for improving maternal and newborn care through women’s groups and other methods of community participation. Two products of the workshop were envisaged: (1) a journal supplement reporting the findings presented at the workshop and (2) methodological guidelines for program managers and researchers for conducting formative research on newborn health interventions. Several lessons from these studies are useful for national programs aiming to improve newborn care practices. The first paper of this supplement summarizes the key lessons learned from formative research studies in Ghana, India, Nepal and Bangladesh. This is followed by site-specific papers describing community practices related to childbirth, breastfeeding initiation, umbilical cord and skin care, care of low-birth-weight infants and care seeking for illness. The last two papers describe the processes of using formative research findings in the design of a women’s group intervention in Nepal and of a home-based newborn care intervention in Ghana. The methodological guidelines have been drafted and will be published separately. We would like to thank the United States Agency for International Development (USAID) for the financial support provided to WHO for the organization of the workshop and Gil Martin who helped bring this supplement to fruition. We hope that the papers in this supplement will be used in many developing countries, particularly in Asia and Africa, for developing and implementing programs for improving newborn care practices. We also hope that it will inspire and inform program managers and researchers interested in newborn health to conduct additional formative research needed in their settings for designing interventions to improve newborn care practices.