Naushero Feroze Neonatal Survival Project
Condition: Birth Asphyxia; Very Low Birth Weight Baby; Neonatal Sepsis
MeSH terms: Sepsis; Neonatal Sepsis; Asphyxia Neonatorum; Birth Weight; Asphyxia
Study type: Interventional

Summary: 
      The present study will be carried out in close collaboration with the National Program for
      Lady Health Workers, a Ministry of Health program with 100,000 Lady Health Workers covering
      60% of the rural population of Pakistan. A team of Lady Health Workers and a Traditional
      Birth Attendant will provide care to the mothers and newborns at household level. A Basic
      Health Unit will take care of non complicated referrals and provide injectable antibiotics
      for neonatal sepsis. Complicated (definitions given in methods section) cases will be
      referred by the LHWs/BHUs to the District Headquarter Hospital which will have a functioning
      neonatal care unit. The District Health Services, Naushero Feroz, Provincial Department of
      Health, Sindh and the Federal Ministry of Health are study collaborators, therefore,
      guaranteeing scaling up of interventions at national level.

      Hypothesis:

      In comparison to a basic package of existing training program of LHWs, enhanced training of
      LHWs and TBAs in the early recognition and management of birth asphyxia, serious newborn
      infections and LBW (combined with prompt referral) will result in an additional 30% reduction
      in neonatal mortality.
    

Detailed description: 
      The proposed body of work addresses important major determinants and immediate causes of
      neonatal mortality in Pakistan. The recent DHS survey indicates that three causes
      prematurity, birth asphyxia and serious infections account for approximately 85% of the
      burden of newborn deaths in Pakistan (PDHS 2007). The recent evidence base of interventions
      for neonatal interventions clearly indicates that the investigators have a basis for action
      and several interventions that can make a difference to outcomes. Several of these
      interventions are clearly feasible within the health system and a fundamental point would be
      the assurance of skilled care and services for newborn resuscitation, basic preterm care and
      management of referred cases with neonatal infections within the health facilities (RHCs, THQ
      and DHQ hospitals in the catchment district). However, given the fact that the vast majority
      of neonatal birth and deaths still occur in community settings, the added value is the
      implementation of relevant interventions in community settings. To illustrate, the figure
      below indicates the potential interventions, links between them and pathways for reduction in
      the exposure to and adverse outcomes from neonatal sepsis. Although the algorithm suggests
      that severe neonatal infections should be referred for further care in facility settings, it
      is recognized that in some situations where care seeking may neither be possible nor
      feasible, treatment for neonatal sepsis may need to be provided at domiciliary or community
      level (i.e. through community based clinics or BHUs).

      Research questions

      Can a package of community-based interventions, linked to strengthened health facilities,
      reduce NMR and be feasibly delivered, with interventions focused on training TBAs & LHWs to
      be linked such that LHWs recognize and provide immediate/early management of the newborn
      complications - birth asphyxia, serious newborn infection, and low birth weight, in tandem
      with TBAs?

      Can these community-based cadres of care providers improve and sustain skills for the
      provision of quality care for newborn complications of birth asphyxia, serious newborn
      infection, and low birth weight?

      Can community-based strategies of training TBAs and LHWs, and mobilizing communities to focus
      on perinatal health, result in improved knowledge and use of key newborn health practices
      related to prevention of newborn complications such as birth asphyxia, serious newborn
      infections, and complications low birth weight?

      Primary Objectives:

      To develop and implement intervention packages for TBAs and LHWs to reduce the burden of
      birth asphyxia, sepsis and low birth weight and asses their feasibility for potential scale
      up

      To assess the efficacy of this intervention package in reducing all cause neonatal mortality
      at population level

      Secondary Objectives:

      To improve case recognition and management of birth asphyxia, sepsis and LBW by primary care
      health care providers (in both the public and private sector such as Midwives, LHWs and TBAs)
      in primary care settings.

      To evaluate the combined effectiveness of birth asphyxia, sepsis and low birth weight
      interventions delivered by TBAs and LHWs on cause specific neonatal mortality at population
      level.

      To evaluate the effectiveness of using the enhanced intervention package to enhance
      collaboration and linkages between LHWs and TBAs and to increase LHW attendance during home
      deliveries.
    

Intervention name(s): Intervention; Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The LHWs of the selected intervention areas would receive additional training on ENC for identification, management and referral for birth asphyxia, lbw and neonatal sepsis.; The LHWs in the control areas would perform their routine tasks as assigned to them by their program
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Health Services Research
Keywords: Birth asphyxia; Low birth weight; neonatal sepsis; mortality; community based interventions