TY - JOUR
T1 - Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India
T2 - a cluster-randomised controlled trial
AU - Kumar, Vishwajeet
AU - Mohanty, Saroj
AU - Kumar, Aarti
AU - Misra, Rajendra P.
AU - Santosham, Mathuram
AU - Awasthi, Shally
AU - Baqui, Abdullah H.
AU - Singh, Pramod
AU - Singh, Vivek
AU - Ahuja, Ramesh C.
AU - Singh, Jai Vir
AU - Malik, Gyanendra Kumar
AU - Ahmed, Saifuddin
AU - Black, Robert E.
AU - Bhandari, Mahendra
AU - Darmstadt, Gary L.
N1 - Funding Information:
This study was funded by the United States Agency for International Development, Delhi Mission and the Saving Newborn Lives programme of Save the Children-US through a grant from the Bill & Melinda Gates Foundation. We thank Massee Bateman for his extraordinary support throughout the study; Rajiv Tandon (USAID, New Delhi Mission), Neal Brandes, Lily Kak, and Heather Haberle (USAID, Washington, DC), and Anne Tinker, Stephen Wall, and Shyam Thapa (Saving Newborn Lives, Washington DC) for their support. We drew inspiration for our model of community empowerment from the work of Shri Dilip Kumar. We thank Raja Rakesh Pratap Singh and all members of the community of Shivgarh for their active involvement, encouragement, and support; all our community volunteers, community stakeholders, and newborn-care stakeholders, in particular, Jamunaji, Baisain buaji, Shakuntala mammiji, Virendra Chauhan, Gokaran Yadav, Sheshpal Singh, Kamruddin chachaji, Hiralal, Mata Prasad, Prema Devi, Ausaan Das, Kunti, Rajkumari, Premawati, Gangadei, Chauhanin bua, Munni Devi, Krishnavati for enthusiastically volunteering their time and effort; all our Saksham Sahayaks , in particular, Nita Dwivedi, Alok Awasthi, Krishna Singh, Poonam Singh, Anoop Shukla, Chandra Kishore, Sankat Mochan, Raj Kumar Maurya, Amarkant Awasthi, Pavan, Devendra Awasthi, Narendra, Ram Prakash, Mamta; Virendra Kumar for his support and our implementation team for their dedication and commitment towards the successful completion of the trial: Ratnesh Srivastava, Sujeet Verma, Nalin Singh Negi, Adil Hussain Khan, Satyavrat Tripathi, Abhishek Singh, Vishnu Pratap Yadav, Padmaja Pandey, Sanjay Tiwari, Jagdish Kumar, Tashfeen Usmani, Satyaprakash Shukla and Sharad Yadav. We also thank Keya Pandey for her key contributions during the formative phase; John Zeal for instruction in temperature measurement using thermometers and the ThermSpot device; the members of the data safety and monitoring board: P S S Sundar Rao (Emeritus, Christian Medical College, Vellore, India), Ashok Deorari (All India Institute of Medical Sciences, Delhi, India), Jorge Tolosa (Oregon Health Sciences University, Portland, Oregon, USA), and Atanu Kumar Jana (Christian Medical Center, Vellore, India); Narendra K Arora, Vinod Paul, Jose Martines, Rajiv Bahl, Prasanna K Hota, and Bernadette Kumar for their guidance, encouragement, and expert advice; Arvind Saili, V K Srivastava, A Niswade, C M Pandey, Raja Shalender Singh, Teresa Wakeen, and the Lucknow Management Association for their support and encouragement; and the Department of Health and Family Welfare, Government of Uttar Pradesh, for its contributions in evolving and integrating the behaviour change management approach from the Shivgarh trial into the Uttar Pradesh Comprehensive Child Survival Programme.
PY - 2008
Y1 - 2008
N2 - Background: In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. Methods: We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104 123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. Findings: Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0·46 [95% CI 0·35-0·60], p<0·0001) and by 52% in the essential newborn care plus ThermoSpot arm (0·48 [95% CI 0·35-0·66], p<0·0001). Interpretation: A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. Funding: USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.
AB - Background: In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. Methods: We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104 123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. Findings: Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0·46 [95% CI 0·35-0·60], p<0·0001) and by 52% in the essential newborn care plus ThermoSpot arm (0·48 [95% CI 0·35-0·66], p<0·0001). Interpretation: A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. Funding: USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.
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U2 - 10.1016/S0140-6736(08)61483-X
DO - 10.1016/S0140-6736(08)61483-X
M3 - Article
C2 - 18926277
AN - SCOPUS:52949137304
SN - 0140-6736
VL - 372
SP - 1151
EP - 1162
JO - The Lancet
JF - The Lancet
IS - 9644
ER -