Neonatal Sepsis Clinical Trial
Official title:
Naushero Feroze Neonatal Survival Project: A Cluster Randomized Trial to Determine the Effectiveness of Package of Community Based Interventions to Reduce Neonatal Deaths Due to Birth Asphyxia, Low Birth Weight & Neonatal Sepsis
The present study will be carried out in close collaboration with the National Program for
Lady Health Workers, a Ministry of Health program with 100,000 Lady Health Workers covering
60% of the rural population of Pakistan. A team of Lady Health Workers and a Traditional
Birth Attendant will provide care to the mothers and newborns at household level. A Basic
Health Unit will take care of non complicated referrals and provide injectable antibiotics
for neonatal sepsis. Complicated (definitions given in methods section) cases will be
referred by the LHWs/BHUs to the District Headquarter Hospital which will have a functioning
neonatal care unit. The District Health Services, Naushero Feroz, Provincial Department of
Health, Sindh and the Federal Ministry of Health are study collaborators, therefore,
guaranteeing scaling up of interventions at national level.
Hypothesis:
In comparison to a basic package of existing training program of LHWs, enhanced training of
LHWs and TBAs in the early recognition and management of birth asphyxia, serious newborn
infections and LBW (combined with prompt referral) will result in an additional 30% reduction
in neonatal mortality.
The proposed body of work addresses important major determinants and immediate causes of
neonatal mortality in Pakistan. The recent DHS survey indicates that three causes
prematurity, birth asphyxia and serious infections account for approximately 85% of the
burden of newborn deaths in Pakistan (PDHS 2007). The recent evidence base of interventions
for neonatal interventions clearly indicates that the investigators have a basis for action
and several interventions that can make a difference to outcomes. Several of these
interventions are clearly feasible within the health system and a fundamental point would be
the assurance of skilled care and services for newborn resuscitation, basic preterm care and
management of referred cases with neonatal infections within the health facilities (RHCs, THQ
and DHQ hospitals in the catchment district). However, given the fact that the vast majority
of neonatal birth and deaths still occur in community settings, the added value is the
implementation of relevant interventions in community settings. To illustrate, the figure
below indicates the potential interventions, links between them and pathways for reduction in
the exposure to and adverse outcomes from neonatal sepsis. Although the algorithm suggests
that severe neonatal infections should be referred for further care in facility settings, it
is recognized that in some situations where care seeking may neither be possible nor
feasible, treatment for neonatal sepsis may need to be provided at domiciliary or community
level (i.e. through community based clinics or BHUs).
Research questions
Can a package of community-based interventions, linked to strengthened health facilities,
reduce NMR and be feasibly delivered, with interventions focused on training TBAs & LHWs to
be linked such that LHWs recognize and provide immediate/early management of the newborn
complications - birth asphyxia, serious newborn infection, and low birth weight, in tandem
with TBAs?
Can these community-based cadres of care providers improve and sustain skills for the
provision of quality care for newborn complications of birth asphyxia, serious newborn
infection, and low birth weight?
Can community-based strategies of training TBAs and LHWs, and mobilizing communities to focus
on perinatal health, result in improved knowledge and use of key newborn health practices
related to prevention of newborn complications such as birth asphyxia, serious newborn
infections, and complications low birth weight?
Primary Objectives:
To develop and implement intervention packages for TBAs and LHWs to reduce the burden of
birth asphyxia, sepsis and low birth weight and asses their feasibility for potential scale
up
To assess the efficacy of this intervention package in reducing all cause neonatal mortality
at population level
Secondary Objectives:
To improve case recognition and management of birth asphyxia, sepsis and LBW by primary care
health care providers (in both the public and private sector such as Midwives, LHWs and TBAs)
in primary care settings.
To evaluate the combined effectiveness of birth asphyxia, sepsis and low birth weight
interventions delivered by TBAs and LHWs on cause specific neonatal mortality at population
level.
To evaluate the effectiveness of using the enhanced intervention package to enhance
collaboration and linkages between LHWs and TBAs and to increase LHW attendance during home
deliveries.
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