Newborn-care training and perinatal mortality in developing countries

Waldemar A. Carlo, Shivaprasad S. Goudar, Imtiaz Jehan, Elwyn Chomba, Antoinette Tshefu, Ana Garces, Sailajanandan Parida, Fernando Althabe, Elizabeth M. McClure, Richard J. Derman, Robert L. Goldenberg, Carl Bose, Nancy F. Krebs, Pinaki Panigrahi, Pierre Buekens, Hrishikesh Chakraborty, Tyler D. Hartwell, Linda L. Wright, J. M. Belizan, J. DitekemenaA. Tshefu, A. Mohapatra, B. S. Kodkany, S. R. Jafri, O. Pasha, M. Mbelenga, M. Hambidge, M. Douoguih, A. Willoughby, H. Harris

Research output: Contribution to journalArticle

203 Citations (Scopus)

Abstract

Background: Of the 3.7 million neonatal deaths and 3.3 million stillbirths each year, 98% occur in developing countries. An evaluation of community-based interventions designed to reduce the number of these deaths is needed. Methods: With the use of a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (which focuses on routine neonatal care, resuscitation, thermoregulation, breast-feeding, "kangaroo" [skin-to-skin] care, care of the small baby, and common illnesses) and (except in Argentina) in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (which teaches basic resuscitation in depth). The Essential Newborn Care intervention was assessed among 57,643 infants with the use of a before-and-after design. The Neonatal Resuscitation Program intervention was assessed as a cluster-randomized, controlled trial involving 62,366 infants. The primary outcome was neonatal death in the first 7 days after birth. Results: The 7-day follow-up rate was 99.2%. After birth attendants were trained in the Essential Newborn Care course, there was no significant reduction from baseline in the rate of neonatal death from all causes in the 7 days after birth (relative risk with training, 0.99; 95% confidence interval [CI], 0.81 to 1.22) or in the rate of perinatal death; there was a significant reduction in the rate of stillbirth (relative risk with training, 0.69; 95% CI, 0.54 to 0.88; P = 0.003). In clusters of births in which attendants had been randomly assigned to receive training in the Neonatal Resuscitation Program, as compared with control clusters, there was no reduction in the rates of neonatal death in the 7 days after birth, stillbirth, or perinatal death. Conclusions: The rate of neonatal death in the 7 days after birth did not decrease after the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates.

Original languageEnglish (US)
Pages (from-to)614-623
Number of pages10
JournalNew England Journal of Medicine
Volume362
Issue number7
DOIs
StatePublished - Feb 18 2010

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Perinatal Mortality
Developing Countries
Resuscitation
Parturition
Newborn Infant
Stillbirth
Argentina
Confidence Intervals
Guatemala
Macropodidae
Skin Care
Zambia
Democratic Republic of the Congo
Body Temperature Regulation
Pakistan
Rural Population
Perinatal Death
Breast Feeding
India
Randomized Controlled Trials

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Carlo, W. A., Goudar, S. S., Jehan, I., Chomba, E., Tshefu, A., Garces, A., ... Harris, H. (2010). Newborn-care training and perinatal mortality in developing countries. New England Journal of Medicine, 362(7), 614-623. https://doi.org/10.1056/NEJMsa0806033

Newborn-care training and perinatal mortality in developing countries. / Carlo, Waldemar A.; Goudar, Shivaprasad S.; Jehan, Imtiaz; Chomba, Elwyn; Tshefu, Antoinette; Garces, Ana; Parida, Sailajanandan; Althabe, Fernando; McClure, Elizabeth M.; Derman, Richard J.; Goldenberg, Robert L.; Bose, Carl; Krebs, Nancy F.; Panigrahi, Pinaki; Buekens, Pierre; Chakraborty, Hrishikesh; Hartwell, Tyler D.; Wright, Linda L.; Belizan, J. M.; Ditekemena, J.; Tshefu, A.; Mohapatra, A.; Kodkany, B. S.; Jafri, S. R.; Pasha, O.; Mbelenga, M.; Hambidge, M.; Douoguih, M.; Willoughby, A.; Harris, H.

In: New England Journal of Medicine, Vol. 362, No. 7, 18.02.2010, p. 614-623.

Research output: Contribution to journalArticle

Carlo, WA, Goudar, SS, Jehan, I, Chomba, E, Tshefu, A, Garces, A, Parida, S, Althabe, F, McClure, EM, Derman, RJ, Goldenberg, RL, Bose, C, Krebs, NF, Panigrahi, P, Buekens, P, Chakraborty, H, Hartwell, TD, Wright, LL, Belizan, JM, Ditekemena, J, Tshefu, A, Mohapatra, A, Kodkany, BS, Jafri, SR, Pasha, O, Mbelenga, M, Hambidge, M, Douoguih, M, Willoughby, A & Harris, H 2010, 'Newborn-care training and perinatal mortality in developing countries', New England Journal of Medicine, vol. 362, no. 7, pp. 614-623. https://doi.org/10.1056/NEJMsa0806033
Carlo WA, Goudar SS, Jehan I, Chomba E, Tshefu A, Garces A et al. Newborn-care training and perinatal mortality in developing countries. New England Journal of Medicine. 2010 Feb 18;362(7):614-623. https://doi.org/10.1056/NEJMsa0806033
Carlo, Waldemar A. ; Goudar, Shivaprasad S. ; Jehan, Imtiaz ; Chomba, Elwyn ; Tshefu, Antoinette ; Garces, Ana ; Parida, Sailajanandan ; Althabe, Fernando ; McClure, Elizabeth M. ; Derman, Richard J. ; Goldenberg, Robert L. ; Bose, Carl ; Krebs, Nancy F. ; Panigrahi, Pinaki ; Buekens, Pierre ; Chakraborty, Hrishikesh ; Hartwell, Tyler D. ; Wright, Linda L. ; Belizan, J. M. ; Ditekemena, J. ; Tshefu, A. ; Mohapatra, A. ; Kodkany, B. S. ; Jafri, S. R. ; Pasha, O. ; Mbelenga, M. ; Hambidge, M. ; Douoguih, M. ; Willoughby, A. ; Harris, H. / Newborn-care training and perinatal mortality in developing countries. In: New England Journal of Medicine. 2010 ; Vol. 362, No. 7. pp. 614-623.
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abstract = "Background: Of the 3.7 million neonatal deaths and 3.3 million stillbirths each year, 98{\%} occur in developing countries. An evaluation of community-based interventions designed to reduce the number of these deaths is needed. Methods: With the use of a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (which focuses on routine neonatal care, resuscitation, thermoregulation, breast-feeding, {"}kangaroo{"} [skin-to-skin] care, care of the small baby, and common illnesses) and (except in Argentina) in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (which teaches basic resuscitation in depth). The Essential Newborn Care intervention was assessed among 57,643 infants with the use of a before-and-after design. The Neonatal Resuscitation Program intervention was assessed as a cluster-randomized, controlled trial involving 62,366 infants. The primary outcome was neonatal death in the first 7 days after birth. Results: The 7-day follow-up rate was 99.2{\%}. After birth attendants were trained in the Essential Newborn Care course, there was no significant reduction from baseline in the rate of neonatal death from all causes in the 7 days after birth (relative risk with training, 0.99; 95{\%} confidence interval [CI], 0.81 to 1.22) or in the rate of perinatal death; there was a significant reduction in the rate of stillbirth (relative risk with training, 0.69; 95{\%} CI, 0.54 to 0.88; P = 0.003). In clusters of births in which attendants had been randomly assigned to receive training in the Neonatal Resuscitation Program, as compared with control clusters, there was no reduction in the rates of neonatal death in the 7 days after birth, stillbirth, or perinatal death. Conclusions: The rate of neonatal death in the 7 days after birth did not decrease after the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates.",
author = "Carlo, {Waldemar A.} and Goudar, {Shivaprasad S.} and Imtiaz Jehan and Elwyn Chomba and Antoinette Tshefu and Ana Garces and Sailajanandan Parida and Fernando Althabe and McClure, {Elizabeth M.} and Derman, {Richard J.} and Goldenberg, {Robert L.} and Carl Bose and Krebs, {Nancy F.} and Pinaki Panigrahi and Pierre Buekens and Hrishikesh Chakraborty and Hartwell, {Tyler D.} and Wright, {Linda L.} and Belizan, {J. M.} and J. Ditekemena and A. Tshefu and A. Mohapatra and Kodkany, {B. S.} and Jafri, {S. R.} and O. Pasha and M. Mbelenga and M. Hambidge and M. Douoguih and A. Willoughby and H. Harris",
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T1 - Newborn-care training and perinatal mortality in developing countries

AU - Carlo, Waldemar A.

AU - Goudar, Shivaprasad S.

AU - Jehan, Imtiaz

AU - Chomba, Elwyn

AU - Tshefu, Antoinette

AU - Garces, Ana

AU - Parida, Sailajanandan

AU - Althabe, Fernando

AU - McClure, Elizabeth M.

AU - Derman, Richard J.

AU - Goldenberg, Robert L.

AU - Bose, Carl

AU - Krebs, Nancy F.

AU - Panigrahi, Pinaki

AU - Buekens, Pierre

AU - Chakraborty, Hrishikesh

AU - Hartwell, Tyler D.

AU - Wright, Linda L.

AU - Belizan, J. M.

AU - Ditekemena, J.

AU - Tshefu, A.

AU - Mohapatra, A.

AU - Kodkany, B. S.

AU - Jafri, S. R.

AU - Pasha, O.

AU - Mbelenga, M.

AU - Hambidge, M.

AU - Douoguih, M.

AU - Willoughby, A.

AU - Harris, H.

PY - 2010/2/18

Y1 - 2010/2/18

N2 - Background: Of the 3.7 million neonatal deaths and 3.3 million stillbirths each year, 98% occur in developing countries. An evaluation of community-based interventions designed to reduce the number of these deaths is needed. Methods: With the use of a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (which focuses on routine neonatal care, resuscitation, thermoregulation, breast-feeding, "kangaroo" [skin-to-skin] care, care of the small baby, and common illnesses) and (except in Argentina) in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (which teaches basic resuscitation in depth). The Essential Newborn Care intervention was assessed among 57,643 infants with the use of a before-and-after design. The Neonatal Resuscitation Program intervention was assessed as a cluster-randomized, controlled trial involving 62,366 infants. The primary outcome was neonatal death in the first 7 days after birth. Results: The 7-day follow-up rate was 99.2%. After birth attendants were trained in the Essential Newborn Care course, there was no significant reduction from baseline in the rate of neonatal death from all causes in the 7 days after birth (relative risk with training, 0.99; 95% confidence interval [CI], 0.81 to 1.22) or in the rate of perinatal death; there was a significant reduction in the rate of stillbirth (relative risk with training, 0.69; 95% CI, 0.54 to 0.88; P = 0.003). In clusters of births in which attendants had been randomly assigned to receive training in the Neonatal Resuscitation Program, as compared with control clusters, there was no reduction in the rates of neonatal death in the 7 days after birth, stillbirth, or perinatal death. Conclusions: The rate of neonatal death in the 7 days after birth did not decrease after the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates.

AB - Background: Of the 3.7 million neonatal deaths and 3.3 million stillbirths each year, 98% occur in developing countries. An evaluation of community-based interventions designed to reduce the number of these deaths is needed. Methods: With the use of a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (which focuses on routine neonatal care, resuscitation, thermoregulation, breast-feeding, "kangaroo" [skin-to-skin] care, care of the small baby, and common illnesses) and (except in Argentina) in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (which teaches basic resuscitation in depth). The Essential Newborn Care intervention was assessed among 57,643 infants with the use of a before-and-after design. The Neonatal Resuscitation Program intervention was assessed as a cluster-randomized, controlled trial involving 62,366 infants. The primary outcome was neonatal death in the first 7 days after birth. Results: The 7-day follow-up rate was 99.2%. After birth attendants were trained in the Essential Newborn Care course, there was no significant reduction from baseline in the rate of neonatal death from all causes in the 7 days after birth (relative risk with training, 0.99; 95% confidence interval [CI], 0.81 to 1.22) or in the rate of perinatal death; there was a significant reduction in the rate of stillbirth (relative risk with training, 0.69; 95% CI, 0.54 to 0.88; P = 0.003). In clusters of births in which attendants had been randomly assigned to receive training in the Neonatal Resuscitation Program, as compared with control clusters, there was no reduction in the rates of neonatal death in the 7 days after birth, stillbirth, or perinatal death. Conclusions: The rate of neonatal death in the 7 days after birth did not decrease after the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates.

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