Newborn Home Intervention Trial (NEWHINTS)

Background:

Just under four million babies die each year before reaching one month of age. Child survival revolution of the 1980s led to dramatic reductions in overall child mortality, but had little impact on neonatal mortality. Neonatal deaths now account for 38% of the 10.8 million deaths among children younger than 5 years of age. Ninety eight percent (98%) of these are in low- & middle-income countries. Tackling neonatal mortality is essential if the child mortality component of the Millennium Development Goals is to be achieved (MDG-4: to reduce by 2015 overall child mortality by two-thirds from its levels in 1990). The main direct causes of neonatal deaths such as infections and the indirect causes like low birth weight are known. A large proportion of deliveries take place at home; Postnatal care for mothers and neonates are either not available or of poor quality. However, the Lancet neonatal series suggests that up to 50% of neonatal deaths could be prevented through promotion of a few key practices like clean home delivery, hygienic cord care, thermal care, early and exclusive breastfeeding and care seeking for illness. Developing an intervention to arrest this situation will call for getting the needed care or practices to the women in their homes and this must be through a system that will be feasible and sustainable.

Aim of the study

The aim of the study is to develop a feasible and sustainable communitybased approach to improve neonatal survival in rural Ghana. This is hoped to be achieved through routine home visits by Community Based Surveillance Volunteers (CBSV) to provide a package of essential newborn care interventions in the third trimester of pregnancy and first week of life. An evaluation of the impact of these visits on all cause neonatal mortality and newborn care practices will then be assessed.

Field Activities:

The second phase will be the implementation of the intervention which will involve the use of Community Based Surveillance Volunteers to deliver a package of essential newborn care interventions in the third trimester and again in the first week of life. The third and final phase will involve the evaluation data collection and monitoring, analysis and dissemination of findings.

The study is a cluster-randomized trial and will span a period of three years from 2006 to 2009. The trial is in 3 phases; the first phase involved the intervention design. A series of formative research activities aimed at identifying gaps in knowledge and to improve the feasibility and optimality of the planned intervention were conducted within the year under review. The lessons learnt from this exercise will be used to design the intervention materials. There will also be baseline data collection and evaluation preparation which will include specifying the randomization units and randomizing.

Sponsors: WHO/SNL
Contact: Alex Manu
E-mail: makmanu128@yahoo.co.uk