Home-based Newborn Care Research Articles

Cost of neonatal intensive care delivered through district level public hospitals in India

To assess the unit cost of level II neonatal intensive care treatment delivered through public hospitals and its fiscal implications in India. Cost analysis study. Four Special Care Newborn Units (SCNUs) in public sector district hospitals in three Indian states, i.e. Bihar, Madhya Pradesh and Orissa, for the period 2010. Bottom-up economic costing methodology was adopted. Health system resources, i.e. capital, equipment, drugs and consumables, non-consumables, referral and overheads, utilized to treat all neonates during 2010 were elicited. Additionally, 360 randomly selected treatment files of neonates were screened to estimate direct out-of-pocket (OOP) expenditure borne by the patients. In order to account for variability in prices and other parameters, we undertook a univariate sensitivity analysis. Unit cost was computed as INR (Indian national rupees) per neonate treated and INR per bed-day treatment in SCNU. Standardized costs per neonate treatment and per bed day were estimated to incorporate the variation in bed occupancy rates across the sites. Overall, SCNU neonatal treatment costs the Government INR 4581 (USD 101.8) and INR 818 (USD 18.2) per neonate treatment and per bed-day treatment, respectively. Standardized treatment costs were estimated to be INR 5090 (USD 113.1) per neonate and INR 909 (USD 20.2) per bed-day treatment. In the event of entire direct medical expenditure being borne by the health system, we found cost of SCNU treatment as INR 4976 (USD 110.6) per neonate and INR 889 (USD 19.8) per bed-day. Level II neonatal intensive care at SCNUs is cost intensive. Rational use of SCNU services by targeting its utilization for the very low birth weight neonates and maintenance of community based home-based newborn care is required. Further research is required on cost-effectiveness of level II neonatal intensive care against routine pediatric ward care.

High Neonatal Mortality Rates in Rural India: What Options to Explore?

The neonatal mortality rate in India is amongst the highest in the world and skewed towards rural areas. Nonavailability of trained manpower along with poor healthcare infrastructure is one of the major hurdles in ensuring quality neonatal care. We reviewed case studies and relevant literature from low and middle income countries and documented alternative strategies that have proved to be favourable in improving neonatal health. The authors reiterate the fact that recruiting and retaining trained manpower in rural areas by all means is essential to improve the quality of neonatal care services. Besides this, other strategies such as training of local rural healthcare providers and traditional midwives, promoting home-based newborn care, and creating community awareness and mobilization also hold enough potential to influence the neonatal health positively and efforts should be made to implement them on a larger scale. More research is demanded for innovations such as “m-health” and public-private partnerships as they have been shown to offer potential in terms of improving the standards of care. The above proposed strategy is likely to reduce morbidity among neonatal survivors as well.

Strengthening support mechanisms for Accredited Social Health Activists in order to improve home-based newborn care in Uttar Pradesh, India

Accredited Social Health Activists (ASHAs) are female frontline health workers that provide critical antenatal and postnatal support to mothers and newborns for over five million deliveries in Uttar Pradesh every year. Performance reviews of ASHAs showed that even after initial training, the quality and the numbers of home visits made by ASHA were inadequate. ASHAs lacked interpersonal communication and counseling skills to effectively negotiate behavior change for home-based newborn care. The health system lacked mechanisms for continued learning and periodic upgrading of their skills and knowledge. Post-training, ASHAs were not being adequately supervised.

Role of Cultural Beliefs in Influencing Selected Newborn Care Practices in Rural Haryana

The role of prevalent culturally driven beliefs and practices in influencing home-based newborn care has not been adequately studied, especially in North India. The study was conducted in 28 villages under Comprehensive Rural Health Services Project (CRHSP), All India Institute of Medical Sciences (AIIMS). A total of 415 mothers who had a baby in the second month of life, at the time of the visit for data collection were interviewed using pre-tested questionnaire. Nearly 77% of mothers reported some beliefs/practices with regard to care of the cord. Similarly, 81.0% mothers had beliefs regarding taking the baby out of the house for the first time after birth. Out of all the mothers that were interviewed, around 11% did not prefer their baby to be weighed at frequent intervals because according to them, doing so could lead to slowing of the growth of the baby. Traditional knowledge and practices must be considered before developing neonatal health care intervention strategies.

Newborn health initiatives in NGO sector

In India many non-profit, voluntary, non-government organizations (NGOs) are working amongst marginalized, poor population in remote villages and crowded urban slums, and have demonstrated the possibility of sustained and considerable reduction of neonatal mortality and morbidity by shifting the focus to integrated Maternal and Newborn Healthcare (MNH) rather than a diluted approach of Maternal and Child Health care (MCH). Initiatives by these NGOs include advocacy for newborn care, capacity building of local traditional birth attendants for safe delivery and childbirth, effective package of home-based newborn care and promotion of primary newborn care as Essential Newborn Care (ENBC). In addition these organizations have created fresh human resources for newborn care in the form of Village Health Workers (VHW) or volunteers and similar link workers or change agents and demonstrated their potential. Other initiatives have been developing database through verbal autopsy or other suitable reporting system, production and distribution of Disposable Delivery Kits (DDK) and training and health education material, developing initiatives for the care of newborns in urban slums, providing level II services for newborn care, innovations of simple tools and equipment, promotion of proper breast feeding and lactation management, emergency transport system and others.

Introduction: Using research for improved delivery of newborn health interventions

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.