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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| Published in: | The Lancet (British edition) Vol. 372; no. 9644; pp. 1151 - 1162 |
|---|---|
| Main Authors: | , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
England
Elsevier Ltd
27.09.2008
Elsevier Limited |
| Subjects: | |
| ISSN: | 0140-6736, 1474-547X, 1474-547X |
| Online Access: | Get full text |
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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-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. 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.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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| Contributor | Awasthi, Shally Yadav, Ranjanaa Mitra, M K Kumar, Vishwajeet Singh, Smita Baqui, Abdullah H Misra, Rajendra P Gupta, Amit Darmstadt, Gary L Gupta, Sanjay Mohanty, Saroj Singh, Pramod Mehrotra, Hina Malik, G K Singh, Richa Winch, Peter J Kumar, Aarti Black, Robert E Bhandari, Mahendra Singh, J V Ahuja, R C Singh, Vivek Santosham, Mathuram Singh, Kamlesh Bharti, Neetu |
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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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