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Home-Based Neonatal Care: Summary and Applications of the Field Trial in Rural Gadchiroli, India (1993 to 2003)

Abstract

High levels of neonatal mortality and lack of access to neonatal health care are widespread problems in developing countries. A field trial of home-based neonatal care (HBNC) was conducted in rural Gadchiroli, India to develop and test the feasibility of a low-cost approach of delivering primary neonatal care by using the human potential available in villages, and to evaluate its effect on neonatal mortality. In the first half of this article we summarize various aspects of the field trial, presented in the previous 11 articles in this issue of the journal supplement. The background, objectives, study design and interventions in the field trial and the results over 10 years (1993 to 2003) are presented. Based on these results, the hypotheses are tested and conclusions presented. In the second half, we discuss the next questions: Can it be replicated? Can this intervention become a part of primary health-care services? What is the cost and the cost-effectiveness of HBNC? The limitations of the approach, the settings where HBNC might be relevant and the management pre-requisites for its scaling up are also discussed. The need to develop an integrated approach is emphasized. A case for newborn care in the community is made for achieving equity in health care.

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References

  1. Save the children, State of the World's Newborns. Save the Children. Washington, DC; 2001.

  2. Bale JR, Stoll BJ, Lucas AO . The Executive Summary: Improving Birth Outcomes — Meeting the Challenge in the Developing World. Washington DC: Institute of Medicine, The National Academy Press; 2001. p. 3–16.

    Google Scholar 

  3. World Health Organization. Post-Partum Care for the Mother and the Newborn: A Practical Guide. Geneva: WHO; 1998.

  4. World Health Organization. Report of the Fourth Meeting of the Technical Advisory Group, Programme of Acute Respiratory Infections. Geneva: WHO; 1989 (document no. WHO/ARI/89.4).

  5. World Health Organization. Supervisory Skills: Management of the Young Child with an Acute Respiratory Infection. Geneva: WHO; 1990.

  6. Gove S, The WHO Working Group on Guidelines of Integrated Management of the Sick Child. Integrated management of childhood illness by outpatient health workers: technical basis and overview. Bull World Health Org 1997;75 (Suppl):7–24.

  7. Bang AT, Bang RA, Mornkar VP, Sontakke PG, Solanki JM . Pneumonia in neonates: can it be managed in the community? Arch Dis Childhood 1993;68:550–556.

    Article  CAS  Google Scholar 

  8. Sutrisna B, Reingold A, Kresno S, et al. Care-seeking for fatal illness in young children in Indramayu, West Java, Indonesi. Lancet 1993;342:887–889.

    Article  Google Scholar 

  9. Bhandari N, Bahl R, Bhatnagar V, Bahn MK . Treating sick young infants in urban slum setting. Lancet 1996;347:1174–1175.

    Article  Google Scholar 

  10. Stoll BJ . Neonatal infections: a global perspective In: Remington JS, Klein JO, editors. Infectious Diseases of the Fetus and Newborn Infant. 6th ed. Philadelphia: WB Saunders Company (in press).

  11. Bang AT, Bang RA . Background of the field trial of home-based neonatal care in Gadchiroli, India. J Perinatol 2005;25:S3–10.

    Article  Google Scholar 

  12. Bang AT, Bang RA, Tale O, et al. Reduction in pneumonia mortality and total childhood mortality by means of community-based intervention trial in Gadchiroli, India. Lancet 1990;336:201–206.

    Article  CAS  Google Scholar 

  13. Bang AT, Rani RA, Reddy HM, Deshmkh M . Methods and the baseline situation in the field trial of home-based neonatal care in Gadchiroli, India. J Perinatol 2005;25:S11–S17.

    Article  Google Scholar 

  14. Bang AT, Reddy HM, Baitule SB, Deshmukh M, Bang RA . The incidence of morbidities in a cohort of neonates in rural Gadchiroli, India: seasonal and temporal variation and a hypotheses about prevention. J Perinatol 2005;25:S18–S28.

    Article  Google Scholar 

  15. Bang AT, Paul VK, Reddy HM, Baitule SB . Why do neonates die in rural Gadchiroli, India? (Part I): Primary causes of death assigned by neonatologist based on prospectively observed records. J Perinatol 2005;25:S29–S34.

    Article  Google Scholar 

  16. Bang AT, Reddy HM, Bang RA, Deshmukh M . Why do neonates die in rural Gadchiroli, India? (Part II): Estimating population attributable risks and contribution of multiple morbidities for identifying a strategy to prevent deaths. J Perinatol 2005;25:S35–S43.

    Article  Google Scholar 

  17. Greenland S, Rothman K . Measures of effect and measures of association In: Rothman K, Greenland S, editors. Modern Epidemiology. 2nd ed. Philadephia: Lippincott-Raven Publ.; 1998. p. 47–65.

    Google Scholar 

  18. Rowe AK, Powel KE, Flanders WD . Why population attributable fractions can sum to more than one. Am J Prev Med 2004;26 (30):243–249.

    Article  Google Scholar 

  19. Reddy HM, Bang AT . How to identify neonates at risk of death in rural India: clinical criteria for the risk approach. J Perinatol 2005;25:S44–S50.

    Article  Google Scholar 

  20. Bang AT, Bang RA, Reddy HM, Baitule SB, Paul VK, Marshal T . Simple clinical criteria to identify sepsis or pneumonia in neonates in the community needing treatment or referral. Ped Inf Dis J (in press).

  21. Bang AT, Baitule SB, Reddy HM, Deshmukh M, Bang RA . Low Birth Weight and Preterm Neonates: Can they be managed at home by mother and a trained village health worker? J Perinatol 2005;25:S72–81.

    Article  Google Scholar 

  22. Bang AT, Bang RA, Stoll BJ, Baitule SB, Reddy HM, Deshmukh M . Is home-based diagnosis and treatment of neonatal sepsis feasible and effective? Seven years of intervention in the Gadchiroli field trial (1996–2003). J Perinatol 2005;25:S62–71.

    Article  Google Scholar 

  23. Bang AT, Baitule SB, Reddy HM, Deshmukh M . Management of birth asphyxia in home deliveries in rural Gadchiroli: the effect of two types of birth attendants and of resuscitating with mouth-to-mouth, tube-mask or bag-mask. J Perinatol 2005;25:S82–91.

    Article  Google Scholar 

  24. Bang AT, Bang RA, Reddy HM, Deshmukh M, Baitule SB . Reduced incidence of neonatal morbidities: Effect of home-based neonatal care in rural Gadchiroli, India. J Perinatol 2005;25:S51–61.

    Article  Google Scholar 

  25. Bang AT, Bang RA, Baitule S, Reddy MH, Deshmukh M . Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 1999;354:1955–1961.

    Article  CAS  Google Scholar 

  26. Bang AT, Reddy HM, Deshmukh M, Baitule SB, Bang RA . Neonatal and infant mortality in the ten years (1993–2003) of the Gadchiroli Field Trial: effect of home-based neonatal care. J Perinatol 2005;25:S92–107.

    Article  Google Scholar 

  27. Government of India. The National Population Policy (2000). New Delhi: Ministry of Health and Family Welfare, Government of India; 2001.

  28. Murry CJL . Qualifying the burden of disease: the technical basis for disability-adjusted life years. In: Murry CJL, Lopez AD, editors. Global Comparative Assessments in the Health Sector: Disease Burden, Expenditures and Intervention Packages. Geneva: World Health Organization; 1994.

    Google Scholar 

  29. Harenda de Silva DG . Perinatal Care in Sri Lanka: secrets of success in a low-income country. Sem Neonatology 1999;3 (4):201–208.

    Article  Google Scholar 

  30. Bang RA, Bang AT, Baitule SB, Choudhary Y, et al. High prevalence of gynecological diseases in rural Indian women. Lancet 1989;i:85–88.

    Article  Google Scholar 

  31. Bang RA, Bang AT, Reddy MH, Deshmukh MD, et al. Maternal morbidity during labour and the puerperium in rural homes and the need for medical attention: a prospective observational study in Gadchiroli, India. BJOG 2004;111:231–238.

    Article  Google Scholar 

  32. Bang RA, Bang AT and SEARCH team. Commentary on a community-based approach to reproductive health care. Int J Gynecol Obstet 1989;3:125–129.

    Article  CAS  Google Scholar 

  33. Li F, Fortney JA, Kotelchuck M, Glover LH . The post-partum care: the key to maternal mortality. Int J Gy-OB 1996;54:1–10.

    Article  CAS  Google Scholar 

  34. Manandhar DS, Osrin D, Shreshtha BP, et al. Effect of a participatory intervention with women's groups on birth outcome in Nepal: cluster-randomized controlled trial. Lancet 2004;364:970–979.

    Article  Google Scholar 

  35. Mosley WH, Becker S . Demographic models for child survival and implications for health intervention programs. Health Policy Plann 1991;6 (3):218–233.

    Article  Google Scholar 

  36. United Nations General Assembly. United Nations Millenium Declaration; Resolution 55/2 September 18, 2000. Available at http://:www.un.org/millennium/declaration/ares552e.pdf(accessed April 23, 2004).

  37. Task force on Health Systems Research. Informed choices for attaining the Millennium Development Goals: towards an international cooperative agenda for health-systems research. Lancet 2004;364:997–1003.

  38. Hongoro Charles, McPake Barbara . How to bridge the gap in human resources for health. Lancet 2004;364:1451–1456.

    Article  Google Scholar 

  39. Taylor CE, Kielmann AA, DeSweemer C, Chernchovsky D . The Narangwal nutrition experiment: background and summary of findings In: Kielmann AA, Taylor CE, DeSweemer C et al., editors. Child and Maternal Health Services in Rural India. Vol I. Baltimore: The Johns Hopkins University Press; 1983. p. 3–30.

    Google Scholar 

  40. Consensus Statement of the National Workshop on Home-based Neonatal Care jointly organized by the Indian Academy of Pediatrics, National Neonatology Forum of India, UNICEF and SEARCH. SEARCH, Gadchiroli, India, 1999.

  41. Consensus Statement of the National Workshop on ‘How to Reduce the IMR to 30’, 31 March–1 April 2003, SEARCH, Gadchiroli, India.

  42. Save the Children. State of India's Newborns. National Neonatology Forum of India and Save the Children, US. New Delhi; 2004. p. 92–4.

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Correspondence to Abhay T Bang MD, MPH.

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Financial support was provided by the John D. and Catherine T. MacArthur Foundation, The Ford Foundation, Saving Newborn Lives, Save the Children, USA, and The Bill & Melinda Gates Foundation.

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Bang, A., Bang, R. & Reddy, H. Home-Based Neonatal Care: Summary and Applications of the Field Trial in Rural Gadchiroli, India (1993 to 2003). J Perinatol 25 (Suppl 1), S108–S122 (2005). https://doi.org/10.1038/sj.jp.7211278

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