Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India

Abdullah Baqui, Emma K. Williams, Amanda M. Rosecrans, Praween K. Agrawal, Saifuddin Ahmed, Gary L. Darmstadt, Vishwajeet Kumar, Usha Kiran, Dharmendra Panwar, Ramesh C. Ahuja, Vinod K. Srivastava, Robert E Black, Mathuram Santosham

Research output: Contribution to journalArticle

Abstract

Objective: To assess the impact of the newborn health component of a large-scale community-based integrated nutrition and health programme. Methods: Using a quasi-experimental design, we evaluated a programme facilitated by a nongovernmental organization that was implemented by the Indian government within existing infrastructure in two rural districts of Uttar Pradesh, northern India. Mothers who had given birth in the 2 years preceding the surveys were interviewed during the baseline (n = 14 952) and endline (n = 13 826) surveys. The primary outcome measure was reduction of neonatal mortality. Findings: In the intervention district, the frequency of home visits by community-based workers increased during both antenatal (from 16% to 56%) and postnatal (from 3% to 39%) periods, as did frequency of maternal and newborn care practices. In the comparison district, no improvement in home visits was observed and the only notable behaviour change was that women had saved money for emergency medical treatment. Neonatal mortality rates remained unchanged in both districts when only an antenatal visit was received. However, neonates who received a postnatal home visit within 28 days of birth had 34% lower neonatal mortality (35.7 deaths per 1000 live births, 95% confidence interval, CI: 29.2-42.1) than those who received no postnatal visit (53.8 deaths per 1000 live births, 95% CI: 48.9-58.8), after adjusting for sociodemographic variables. Three-quarters of the mortality reduction was seen in those who were visited within the first 3 days after birth. The effect on mortality remained statistically significant when excluding babies who died on the day of birth. Conclusion: The limited programme coverage did not enable an effect on neonatal mortality to be observed at the population level. A reduction in neonatal mortality rates in those receiving postnatal home visits shows potential for the programme to have an effect on neonatal deaths.

Original languageEnglish (US)
Pages (from-to)796-804
Number of pages9
JournalBulletin of the World Health Organization
Volume86
Issue number10
DOIs
StatePublished - Oct 2008

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Infant Mortality
House Calls
India
Parturition
Health
Mortality
Live Birth
Mothers
Newborn Infant
Emergency Treatment
Research Design
Outcome Assessment (Health Care)
Organizations
Confidence Intervals
Population
Surveys and Questionnaires

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India. / Baqui, Abdullah; Williams, Emma K.; Rosecrans, Amanda M.; Agrawal, Praween K.; Ahmed, Saifuddin; Darmstadt, Gary L.; Kumar, Vishwajeet; Kiran, Usha; Panwar, Dharmendra; Ahuja, Ramesh C.; Srivastava, Vinod K.; Black, Robert E; Santosham, Mathuram.

In: Bulletin of the World Health Organization, Vol. 86, No. 10, 10.2008, p. 796-804.

Research output: Contribution to journalArticle

Baqui, A, Williams, EK, Rosecrans, AM, Agrawal, PK, Ahmed, S, Darmstadt, GL, Kumar, V, Kiran, U, Panwar, D, Ahuja, RC, Srivastava, VK, Black, RE & Santosham, M 2008, 'Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India', Bulletin of the World Health Organization, vol. 86, no. 10, pp. 796-804. https://doi.org/10.2471/BLT.07.042226
Baqui, Abdullah ; Williams, Emma K. ; Rosecrans, Amanda M. ; Agrawal, Praween K. ; Ahmed, Saifuddin ; Darmstadt, Gary L. ; Kumar, Vishwajeet ; Kiran, Usha ; Panwar, Dharmendra ; Ahuja, Ramesh C. ; Srivastava, Vinod K. ; Black, Robert E ; Santosham, Mathuram. / Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India. In: Bulletin of the World Health Organization. 2008 ; Vol. 86, No. 10. pp. 796-804.
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abstract = "Objective: To assess the impact of the newborn health component of a large-scale community-based integrated nutrition and health programme. Methods: Using a quasi-experimental design, we evaluated a programme facilitated by a nongovernmental organization that was implemented by the Indian government within existing infrastructure in two rural districts of Uttar Pradesh, northern India. Mothers who had given birth in the 2 years preceding the surveys were interviewed during the baseline (n = 14 952) and endline (n = 13 826) surveys. The primary outcome measure was reduction of neonatal mortality. Findings: In the intervention district, the frequency of home visits by community-based workers increased during both antenatal (from 16{\%} to 56{\%}) and postnatal (from 3{\%} to 39{\%}) periods, as did frequency of maternal and newborn care practices. In the comparison district, no improvement in home visits was observed and the only notable behaviour change was that women had saved money for emergency medical treatment. Neonatal mortality rates remained unchanged in both districts when only an antenatal visit was received. However, neonates who received a postnatal home visit within 28 days of birth had 34{\%} lower neonatal mortality (35.7 deaths per 1000 live births, 95{\%} confidence interval, CI: 29.2-42.1) than those who received no postnatal visit (53.8 deaths per 1000 live births, 95{\%} CI: 48.9-58.8), after adjusting for sociodemographic variables. Three-quarters of the mortality reduction was seen in those who were visited within the first 3 days after birth. The effect on mortality remained statistically significant when excluding babies who died on the day of birth. Conclusion: The limited programme coverage did not enable an effect on neonatal mortality to be observed at the population level. A reduction in neonatal mortality rates in those receiving postnatal home visits shows potential for the programme to have an effect on neonatal deaths.",
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AU - Baqui, Abdullah

AU - Williams, Emma K.

AU - Rosecrans, Amanda M.

AU - Agrawal, Praween K.

AU - Ahmed, Saifuddin

AU - Darmstadt, Gary L.

AU - Kumar, Vishwajeet

AU - Kiran, Usha

AU - Panwar, Dharmendra

AU - Ahuja, Ramesh C.

AU - Srivastava, Vinod K.

AU - Black, Robert E

AU - Santosham, Mathuram

PY - 2008/10

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N2 - Objective: To assess the impact of the newborn health component of a large-scale community-based integrated nutrition and health programme. Methods: Using a quasi-experimental design, we evaluated a programme facilitated by a nongovernmental organization that was implemented by the Indian government within existing infrastructure in two rural districts of Uttar Pradesh, northern India. Mothers who had given birth in the 2 years preceding the surveys were interviewed during the baseline (n = 14 952) and endline (n = 13 826) surveys. The primary outcome measure was reduction of neonatal mortality. Findings: In the intervention district, the frequency of home visits by community-based workers increased during both antenatal (from 16% to 56%) and postnatal (from 3% to 39%) periods, as did frequency of maternal and newborn care practices. In the comparison district, no improvement in home visits was observed and the only notable behaviour change was that women had saved money for emergency medical treatment. Neonatal mortality rates remained unchanged in both districts when only an antenatal visit was received. However, neonates who received a postnatal home visit within 28 days of birth had 34% lower neonatal mortality (35.7 deaths per 1000 live births, 95% confidence interval, CI: 29.2-42.1) than those who received no postnatal visit (53.8 deaths per 1000 live births, 95% CI: 48.9-58.8), after adjusting for sociodemographic variables. Three-quarters of the mortality reduction was seen in those who were visited within the first 3 days after birth. The effect on mortality remained statistically significant when excluding babies who died on the day of birth. Conclusion: The limited programme coverage did not enable an effect on neonatal mortality to be observed at the population level. A reduction in neonatal mortality rates in those receiving postnatal home visits shows potential for the programme to have an effect on neonatal deaths.

AB - Objective: To assess the impact of the newborn health component of a large-scale community-based integrated nutrition and health programme. Methods: Using a quasi-experimental design, we evaluated a programme facilitated by a nongovernmental organization that was implemented by the Indian government within existing infrastructure in two rural districts of Uttar Pradesh, northern India. Mothers who had given birth in the 2 years preceding the surveys were interviewed during the baseline (n = 14 952) and endline (n = 13 826) surveys. The primary outcome measure was reduction of neonatal mortality. Findings: In the intervention district, the frequency of home visits by community-based workers increased during both antenatal (from 16% to 56%) and postnatal (from 3% to 39%) periods, as did frequency of maternal and newborn care practices. In the comparison district, no improvement in home visits was observed and the only notable behaviour change was that women had saved money for emergency medical treatment. Neonatal mortality rates remained unchanged in both districts when only an antenatal visit was received. However, neonates who received a postnatal home visit within 28 days of birth had 34% lower neonatal mortality (35.7 deaths per 1000 live births, 95% confidence interval, CI: 29.2-42.1) than those who received no postnatal visit (53.8 deaths per 1000 live births, 95% CI: 48.9-58.8), after adjusting for sociodemographic variables. Three-quarters of the mortality reduction was seen in those who were visited within the first 3 days after birth. The effect on mortality remained statistically significant when excluding babies who died on the day of birth. Conclusion: The limited programme coverage did not enable an effect on neonatal mortality to be observed at the population level. A reduction in neonatal mortality rates in those receiving postnatal home visits shows potential for the programme to have an effect on neonatal deaths.

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