TABLE 41.

Neonatal Care Packages

SourceLocation and Type of TrialInterventionMaternal OutcomePerinatal/Neonatal Outcome
Bang et al439See Tables 26 and 39
O'Rourke et al734Bolivia; rural setting; PCSGroups followed a 4-stage community action cycle to identify needs and practical solutions to problems that led to maternal and perinatal mortality. The impact of this intervention was evaluated by comparing PMRs and obstetric behavior among community women (n = 409) before and after the intervention.There was an increase in the users of contraceptives from an estimated baseline of ∼0–1% to 27%. There was a 71% increase in tetanus immunization in women. An increase in attendance at antenatal clinics was observed. Women resorted more to trained Dais (trained birth attendants) as opposed to untrained Dais for delivery.There was a 63% decrease in PMR after the intervention compared to baseline (44 deaths/1000 births vs 117 deaths/1000 births, respectively; P < .001).
Manandhar et al665; Osrin et al69Nepal; rural setting; RCTLocal female facilitators in intervention villages were trained to lead discussions within village development committees and women's groups about perinatal health issues. The groups then developed participatory action plans to solve perinatal health problems in an iterative process to reach 28 000 married women of reproductive age. Common goals of the action plans included surveillance of birth outcomes, caregiver recognition of danger signs, improved health worker knowledge and skills, clean delivery, early breastfeeding, and improved referrals.Maternal mortality was significantly reduced in the intervention clusters compared to the control clusters (OR: 022; CI: 0.05–0.90).A 30% reduction in IMR was observed in the intervention clusters compared to the control clusters (OR: 0.70; CI: 0.53–0.94).
Daga492India; rural setting; PCS6 babies with a foot length of <6 cm, whose mothers were not willing for hospital care, were managed at home using trained health workers.All 6 newborn infants survived and did not require admission to the hospital.
Schieber et al735Guatemala; rural setting; CCS100 cases were obtained through a random sample of all perineonatal deaths. 120 controls were selected by enrolling the next registered birth after the study case in which the infant lived for at least 28 d). Mothers were interviewed, and data were reviewed by physicians to identify probable cause of death. 2 analyses were performed, first to identify predictors of perineonatal mortality and, second, to compare baseline characteristics between women who elected traditional as opposed to modern care.Population-based attributable risks related to prematurity, malpresentation, and prolonged labor demonstrated that these complications account for significant proportions of observed perineonatal mortality.
Daga et al449*See Tables 26 and 39
Daga et al441*See Tables 26 and 39
Bartlett et al664Guatemala; rural setting; PCSAll pregnant women identified in the community over a period of 1 y were enrolled. Newborns (n = 320) were seen weekly in the first month and biweekly in months 2 and 3. Mothers were taught routine newborn care by fieldworkers. A physician examined the infants biweekly in the first month and monthly in months 2 and 3. For minor illnesses, physicians provided treatment in the community. For complicated cases, physicians provided immediate treatment in the community, followed by referral.Mortality rate in the first 3 mo of life was reduced by 85%, compared to historical controls.
Pratinidhi et al438 Greenwood et al644See Tables 26 and 39 See Table 39 See Table 6
Kielmann et al118*Morbidity duration was shorter in villages with MC (or NUT + MC) than in NUT or control villages (P < .02). Postneonatal mortality was lower in villages receiving MC or NUT + MC (23.3/1000 and 35.2/1000 live births for MC and NUT + MC groups, respectively) than the control villages (50–52/1000). Difference between combined mortality of villages receiving medical care (MC and NUT + MC) and the control villages was statistically significant (P < .05). The difference between 1 and 7 d mortality in the 3 intervention groups relative to the control group was highly significant (1 d: 28/1000; 7 d: 52.1/1000; P < .005).
Kielmann et al244*India; rural setting; PCSGroups and interventions were the same as Kielmann et al (See Table 6).Mothers in the intervention group prolonged breastfeeding by about 2 mo because of nutrition education given to them.IMR was lowest in the MC group (70/1000 live births), second in the MC + NUT group (81/1000 live births) and third in the NUT group (89/1000 live births) as compared to the control group (129/1000 live births).
  • * Data are from the same trial.