Overview of home care for the newborn
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Transcript Overview of home care for the newborn
WHO/UNICEF Joint Statement on
Home Visits for Newborn Care
Rajiv Bahl
Newborn Health R&D
Department of Child and Adolescent Health and Development
The problem
Close to 3.5 million newborn deaths occur in the world each year
40% of all under-five deaths in the newborn period – most within 7 days
80% of newborn deaths due to preterm birth, asphyxia and infections
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Deaths that Could be Prevented
About half of mothers and newborns in low and middle
income countries do not receive skilled care during birth
Three quarters of all babies born outside a hospital do not
receive any postnatal care
Most sick newborns do not receive appropriate treatment
Over 60% of newborn deaths could be
prevented if all newborns received the above
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Rationale for Community Care
Global decline of child mortality is too slow,
stagnating or even reversing in 52/68 low-income
countries
Optimal coverage of effective interventions will not be
achieved by health facility-based interventions alone
in most high burden countries
Evidence that delivery of selected interventions at the
community level improves health outcomes
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Evidence-base for the Joint Statement
Home Visits for Neonatal Care by Community Health
Workers for Preventing Neonatal Mortality in
Developing Countries: Systematic Review of
Controlled Trials
Gogia S and Sachdev HPS
(accepted for publication in the Bulletin of the World
Health Organization)
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Characteristics of included studies
Sylhet 2008
Hala 2008
Shivgarh
2008
Barabanki
2008
Gadhchiroli
2005
Country
Bangladesh
Pakistan
India
India
India
Baseline NMR
48
52.1
84.2
45.8
65.2
CHW, training
Recruited, 6
weeks
Existing,
days
Recruited, 7
days
Existing,
days
Number of
home visits
Antenatal: 2
Postnatal: 3
in first week
Antenatal: 2
Postnatal: 4
in 4 weeks
Antenatal: 2
Postnatal: 2 in
first week
Antenatal: 1
Postnatal: 1
in 4 weeks
Antenatal: 2
Postnatal: 812 in 4 weeks
Done at
postnatal
home visits
Promote care
Promote care
Promote care
Promote care
Promote care
Assess for
illness
Assess for
illness & refer
Assess for
illness & refer
Assess for
illness & refer
Assess for
illness
Treat sepsis
Treat only
pneumonia
-
-
Treat sepsis
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6
6
Recruited,
4 weeks
Provide care
at birth
38% reduction in neonatal mortality
Pooled effect on NMR: 0.62 (0.44, 0.87)
Risk
%
Study ID
Ratio (95% CI)
Weight
Gadhchiroli 2005
0.39 (0.27, 0.56)
18.49
Barabanki 2008
1.06 (0.81, 1.38)
20.46
Hala 2008
0.70 (0.54, 0.90)
20.67
Shivgarh 2008
0.47 (0.38, 0.58)
21.47
Sylhet 2008
0.66 (0.47, 0.93)
18.91
Overall (I-squared = 86.4%, p = 0.000)
0.62 (0.44, 0.87)
100.00
NOTE: Weights are from random effects analysis
.2
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.5
1
2
5
Effect on newborn care practices
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Barabanki Hala 2008
2008
Shivgarh
2008
Sylhet
2008
Pooled RR
(CI)
Antenatal
care visit >1
1.29
(1.23 - 1.36)
1.20
(1.10-1.32)
1.52
(0.91-2.53)
1.47
(1.39-1.55)
1.33
(1.20-1.47)
Skilled care
at birth
1.03
(1.00 - 1.10)
2.64
(1.99-3.52)
1.38
(0.91-2.09)
-
1.54
(0.81-2.93)
Breastfeedin
g initiated
<1h
6.54
(5.88 - 7.27)
3.14
(2.55-3.86)
4.37
(3.23-5.91)
1.42
(1.36-1.49)
3.35
(1.31-8.59)
Clean cord
care
1.63
(1.57 - 1.70)
47.28
(20.3110.2)
1.15
(1.02-1.29)
1.56
(1.50-1.62)
1.70
(1.39-2.07)
Delayed
bathing >24h
38.49
(28.0 - 52.9)
1.66
(1.39-2.00)
2.49
(2.22-2.79)
3.12
(2.86-3.40)
4.63
(2.29-9.37)
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New evidence expected in 2010
Pakistan: Hala main study completed, under publication
India: Evaluation of IMNCI study in Haryana will be
completed at the end of March
Ghana: Newborn Home Intervention Study will be
completed at the end of March
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Key recommendation:
Home visits for newborn care days one and three after birth,
and if possible, a third visit on day seven
Promote early and exclusive breastfeeding
Help keep the newborn warm
Promote hygienic umbilical cord and skin care
Help the family to recognize signs of illness and promote prompt
care-seeking
Promote birth registration and timely vaccination
Identify and newborns who are low-birth-weight, have illness and
those born to an HIV-infected mother and provide or refer for
additional health care
Counsel the mother about her own health.
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Examples of workers who can conduct
home visits
Community midwives in Indonesia
Anganwadi workers and ASHAs as part of the IMNCI
programme in India
Female community health volunteers in Nepal
Health Surveillance Assistants in Malawi
Health Extension Workers in Ethiopia
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Recommendations for countries
All newborns should receive appropriate care especially in the first
hours and week of life when they are most vulnerable;
Each country should analyse the current policies and practices to
provide such care;
A home visitation programme is recommended where access to
facility-based skilled care is limited;
Home visits should be initiated as soon as possible after birth or
after returning home; and
Postnatal home care by community health workers should be linked to
the health system and the full continuum of care.
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WHO-UNICEF Community Health Worker
Training Package
Caring for the newborn at
home
Promotion of ANC and
skilled care at birth
Promotion of care for the
mother
Newborn care in first week
Recognition and referral
for danger signs
Additional care for Lowbirth-weight babies
Treatment of illness in the
community
Treatment in the community
of
– Diarrhoea
– Malaria
– Pneumonia
Referral of children with
danger signs
Caring for the infants and children at home
Care-giving skills and support for child development
Infant and young child feeding
Family response to child’s illness
Prevention of illness
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Caring for the newborn at home
SEARCH
India
UNICEF/ESARO
Package
2006
C-IMCI
Bolivia
NEWHINTS
Ghana
WHO-UNICEF
Package
CARING FOR THE
NEWBORN AT HOME
2009
WHO
Package
(under development)
IMNCI
India
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2008
4 Field tests
Caring for the Newborn at Home
Two units:
– Home visits before birth
– Home visits after birth
Target: literate CHWs (about 8 years of school)
Duration: 6 days
Methods: Classroom discussion, games, role plays,
videos, clinical practice and field visit.
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Conclusions
Home visits for newborn care by community health
workers improve newborn care practices and survival
The joint WHO-UNICEF statement recommends two
home visits each during pregnancy and first week of life
Home care by community health workers should be
linked to the health system
The generic WHO-UNICEF training package for CHW is
one of the tools to make the joint statement operational
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