Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial

In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. We did a cluster-randomised controlled...

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Veröffentlicht in:The Lancet (British edition) Jg. 372; H. 9644; S. 1151 - 1162
Hauptverfasser: Kumar, Vishwajeet, Mohanty, Saroj, Kumar, Aarti, Misra, Rajendra P, Santosham, Mathuram, Awasthi, Shally, Baqui, Abdullah H, Singh, Pramod, Singh, Vivek, Ahuja, Ramesh C, Singh, Jai Vir, Malik, Gyanendra Kumar, Ahmed, Saifuddin, Black, Robert E, Bhandari, Mahendra, Darmstadt, Gary L
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England Elsevier Ltd 27.09.2008
Elsevier Limited
Schlagworte:
Adult
Behavior
Breast feeding
Child Health Services - organization & administration
Cluster Analysis
Community
Female
Health facilities
Health Knowledge, Attitudes, Practice
Humans
Hypothermia
India - epidemiology
Infant Care - methods
Infant mortality
Infant Mortality - trends
Infant, Newborn
Internal Medicine
International standards
Intervention
Middle Aged
Neonatal care
Neonates
Organizational Innovation
Perinatal care
Pregnancy
Pregnancy Outcome
Prenatal Care - organization & administration
Preventive Health Services - methods
Preventive Health Services - organization & administration
Program Evaluation
Rural areas
Skin
India
Uttar Pradesh India
ISSN:0140-6736, 1474-547X, 1474-547X
Online-Zugang:Volltext
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Abstract In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104 123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0·46 [95% CI 0·35–0·60], p<0·0001) and by 52% in the essential newborn care plus ThermoSpot arm (0·48 [95% CI 0·35–0·66], p<0·0001). A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.
AbstractList In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104 123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-more intervention (rate ratio 0.46 [95% CI 0.35-0.60], p<0.0001) and by 52% in the essential newborn care plus ThermoSpot arm (0.48 [95% CI 0.35-0.66], p<0.0001). A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.
In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104 123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0·46 [95% CI 0·35–0·60], p<0·0001) and by 52% in the essential newborn care plus ThermoSpot arm (0·48 [95% CI 0·35–0·66], p<0·0001). A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.
In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality.BACKGROUNDIn rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality.We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104,123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653.METHODSWe did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104,123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653.Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0.46 [95% CI 0.35-0.60], p<0.0001) and by 52% in the essential newborn care plus ThermoSpot arm (0.48 [95% CI 0.35-0.66], p<0.0001).FINDINGSImprovements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0.46 [95% CI 0.35-0.60], p<0.0001) and by 52% in the essential newborn care plus ThermoSpot arm (0.48 [95% CI 0.35-0.66], p<0.0001).A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development.INTERPRETATIONA socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development.USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.FUNDINGUSAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.
Summary Background In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. Methods We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104 123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. Findings Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0·46 [95% CI 0·35–0·60], p<0·0001) and by 52% in the essential newborn care plus ThermoSpot arm (0·48 [95% CI 0·35–0·66], p<0·0001). Interpretation A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. Funding USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.
In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104,123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0.46 [95% CI 0.35-0.60], p<0.0001) and by 52% in the essential newborn care plus ThermoSpot arm (0.48 [95% CI 0.35-0.66], p<0.0001). A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.
Author Awasthi, Shally
Kumar, Vishwajeet
Kumar, Aarti
Black, Robert E
Bhandari, Mahendra
Singh, Jai Vir
Baqui, Abdullah H
Singh, Vivek
Misra, Rajendra P
Ahuja, Ramesh C
Malik, Gyanendra Kumar
Santosham, Mathuram
Darmstadt, Gary L
Mohanty, Saroj
Singh, Pramod
Ahmed, Saifuddin
Author_xml – sequence: 1
  givenname: Vishwajeet
  surname: Kumar
  fullname: Kumar, Vishwajeet
  organization: International Center for Advancing Neonatal Health (ICANH), Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
– sequence: 2
  givenname: Saroj
  surname: Mohanty
  fullname: Mohanty, Saroj
  organization: Clinical Epidemiology Unit, CSM Medical University, Lucknow, India
– sequence: 3
  givenname: Aarti
  surname: Kumar
  fullname: Kumar, Aarti
  organization: Clinical Epidemiology Unit, CSM Medical University, Lucknow, India
– sequence: 4
  givenname: Rajendra P
  surname: Misra
  fullname: Misra, Rajendra P
  organization: Clinical Epidemiology Unit, CSM Medical University, Lucknow, India
– sequence: 5
  givenname: Mathuram
  surname: Santosham
  fullname: Santosham, Mathuram
  organization: International Center for Advancing Neonatal Health (ICANH), Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
– sequence: 6
  givenname: Shally
  surname: Awasthi
  fullname: Awasthi, Shally
  organization: Clinical Epidemiology Unit, CSM Medical University, Lucknow, India
– sequence: 7
  givenname: Abdullah H
  surname: Baqui
  fullname: Baqui, Abdullah H
  organization: International Center for Advancing Neonatal Health (ICANH), Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
– sequence: 8
  givenname: Pramod
  surname: Singh
  fullname: Singh, Pramod
  organization: Clinical Epidemiology Unit, CSM Medical University, Lucknow, India
– sequence: 9
  givenname: Vivek
  surname: Singh
  fullname: Singh, Vivek
  organization: Clinical Epidemiology Unit, CSM Medical University, Lucknow, India
– sequence: 10
  givenname: Ramesh C
  surname: Ahuja
  fullname: Ahuja, Ramesh C
  organization: Clinical Epidemiology Unit, CSM Medical University, Lucknow, India
– sequence: 11
  givenname: Jai Vir
  surname: Singh
  fullname: Singh, Jai Vir
  organization: Clinical Epidemiology Unit, CSM Medical University, Lucknow, India
– sequence: 12
  givenname: Gyanendra Kumar
  surname: Malik
  fullname: Malik, Gyanendra Kumar
  organization: Clinical Epidemiology Unit, CSM Medical University, Lucknow, India
– sequence: 13
  givenname: Saifuddin
  surname: Ahmed
  fullname: Ahmed, Saifuddin
  organization: International Center for Advancing Neonatal Health (ICANH), Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
– sequence: 14
  givenname: Robert E
  surname: Black
  fullname: Black, Robert E
  organization: International Center for Advancing Neonatal Health (ICANH), Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
– sequence: 15
  givenname: Mahendra
  surname: Bhandari
  fullname: Bhandari, Mahendra
  organization: Vattikuti Urology Institute, Henry Ford Health System, Detroit MI, USA
– sequence: 16
  givenname: Gary L
  surname: Darmstadt
  fullname: Darmstadt, Gary L
  email: gdarmsta@jhsph.edu
  organization: International Center for Advancing Neonatal Health (ICANH), Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
BackLink https://www.ncbi.nlm.nih.gov/pubmed/18926277$$D View this record in MEDLINE/PubMed
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Baqui, Abdullah H
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Malik, G K
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Snippet In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management,...
Summary Background In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour...
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SubjectTerms Adult
Behavior
Breast feeding
Child Health Services - organization & administration
Cluster Analysis
Community
Female
Health facilities
Health Knowledge, Attitudes, Practice
Humans
Hypothermia
India - epidemiology
Infant Care - methods
Infant mortality
Infant Mortality - trends
Infant, Newborn
Internal Medicine
International standards
Intervention
Middle Aged
Neonatal care
Neonates
Organizational Innovation
Perinatal care
Pregnancy
Pregnancy Outcome
Prenatal Care - organization & administration
Preventive Health Services - methods
Preventive Health Services - organization & administration
Program Evaluation
Rural areas
Skin
Title Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial
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