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Effect of community-based newborn care on cause-specific neonatal mortality in Sylhet district, Bangladesh: findings of a cluster-randomized controlled trial

Journal of Perinatology volume 36, pages 71–76 (2016)Cite this article

Subjects

Abstract

Objectives:

Community-based maternal and newborn intervention packages have been shown to reduce neonatal mortality in resource-constrained settings. This analysis uses data from a large community-based cluster-randomized trial to assess the impact of a community-based package on cause-specific neonatal mortality and draws programmatic and policy implications. In addition, the study shows that cause-specific mortality estimates vary substantially based on the hierarchy used in assigning cause of death, which also has important implications for program planning. Therefore, understanding the methods of assigning causes of deaths is important, as is the development of new methodologies that account for multiple causes of death. The objective of this study was to estimate the effect of two service delivery strategies (home care and community care) for a community-based package of maternal and neonatal health interventions on cause-specific neonatal mortality rates in a rural district of Bangladesh.

Study design:

Within the general community of the Sylhet district in rural northeast Bangladesh. Pregnancy histories were collected from a sample of women in the study area during the year preceding the study (2002) and from all women who reported a pregnancy outcome during the intervention in years 2004 to 2005. All families that reported a neonatal death during these time periods were asked to complete a verbal autopsy interview. Expert algorithms with two different hierarchies were used to assign causes of neonatal death, varying in placement of the preterm/low birth weight category within the hierarchy (either third or last). The main outcome measure was cause-specific neonatal mortality.

Result:

Deaths because of serious infections in the home-care arm declined from 13.6 deaths per 1000 live births during the baseline period to 7.2 during the intervention period according to the first hierarchy (preterm placed third) and from 23.6 to 10.6 according to the second hierarchy (preterm placed last).

Conclusion:

This study confirms the high burden of neonatal deaths because of infection in low resource rural settings like Bangladesh, where most births occur at home in the absence of skilled birth attendance and care seeking for newborn illnesses is low. The study demonstrates that a package of community-based neonatal health interventions, focusing primarily on infection prevention and management, can substantially reduce infection-related neonatal mortality.

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Acknowledgements

This research was funded by the United States Agency for International Development (USAID), through cooperative agreements with the Johns Hopkins Bloomberg School of Public Health and the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), and by the Saving Newborn Lives program of Save the Children-US through a grant from the Bill and Melinda Gates Foundation. The study sponsors had no role in the study design, data collection, analysis, interpretation or dissemination, or in the decision to submit this paper for publication. The corresponding author had full access to all the data in the study and had the final responsibility for the decision to submit for publication.

Author contributions

AHB, GLD, SEA and REB designed the original study. AHB, SEA, IM and SMR supervised and supported the study implementation. AHB, EW, NB and SA conceptualized this analysis. EW, NB, SA and AHB conducted the analysis and interpreted the data. EW and AHB drafted the manuscript. JAA provided inputs in the manuscript finalization. All authors reviewed and approved the paper.

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All authors external and internal had full access to the data in the study and can take responsibility for the integrity of the data and accuracy of the analysis.

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Authors and Affiliations

  1. Department of International Health, International Center for Maternal and Newborn Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

    A H Baqui, J A Applegate, S Ahmed & R E Black

  2. International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh

    A H Baqui, S El-Arifeen & S M Rahman

  3. Monitoring, Evaluation and Research Unit, Jhpiego, Baltimore, MD, USA

    E Williams

  4. Health and Nutrition, Save the Children, Dhaka, Bangladesh

    I Mannan

  5. Johns Hopkins University Bangladesh, Dhaka, Bangladesh

    N Begum

  6. Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA

    G L Darmstadt

Authors
  1. A H Baqui
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  2. E Williams
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  3. S El-Arifeen
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  4. J A Applegate
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  5. I Mannan
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  6. N Begum
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  7. S M Rahman
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  8. S Ahmed
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  9. R E Black
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  10. G L Darmstadt
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Consortia

for the Projahnmo Study Group in Bangladesh

  • Moazzem Ali Khan Chowdhury
  • , Nazmul Hassan
  • , Altaf Hossain
  • , Lutfunnahar Jesmin
  • , Abdus Salam Khan
  • , Younus Mian
  • , Habibur Rahman
  • , Mashukur Rahman
  • , Himangshu Lal Roy
  • , Mohammad Sharif
  • , Gour Moni Sinha
  • , Habib Abdullah Sohel
  • , Helal Uddin
  •  & Kutub Uddin

Corresponding author

Correspondence to G L Darmstadt.

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Competing interests

The authors declare no conflict of interest.

Additional information

PROJAHNMO STUDY GROUP IN BANGLADESH Dr. Md. Moazzem Ali Khan Chowdhury, Dr. Nazmul Hassan, Dr. Md. Altaf Hossain, Dr. Lutfunnahar Jesmin, Mr. Md. Abdus Salam Khan, Mr. Younus Mian, Dr. Habibur Rahman, Dr. Mashukur Rahman, Dr. Himangshu Lal Roy, Dr. Mohammad Sharif, Dr. Gour Moni Sinha, Dr. Habib Abdullah Sohel, Mr. Md. Helal Uddin, Mr. Md. Kutub Uddin.

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Baqui, A., Williams, E., El-Arifeen, S. et al. Effect of community-based newborn care on cause-specific neonatal mortality in Sylhet district, Bangladesh: findings of a cluster-randomized controlled trial. J Perinatol 36, 71–76 (2016). https://doi.org/10.1038/jp.2015.139

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  • DOI: https://doi.org/10.1038/jp.2015.139

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