GLOBAL UPDATE; Direct Advice Has Direct Effects On Improving Neonatal Survival
By DONALD G. McNEIL Jr.
Published: June 10, 2008
Four million babies a year die in their first month of life. Very few die in hospital incubators; most were born in huts to mothers helped only by relatives or a village midwife.
A study published last week in The Lancet shows that home visits by even lightly trained health workers can make huge differences in survival.
While death rates of children 2 to 5 have dropped, thanks to measles shots, mosquito nets and other simple measures, deaths among newborns have not budged. Some are caused by birth asphyxiation, which is hard to prevent. But many die from problems easily prevented or cured: pneumonia, blood infections or tetanus.
The study, led by doctors from the Johns Hopkins Bloomberg School of Public Health and paid for by the United States Agency for International Development, followed about 45,000 births in three groups of women in the Sylhet district of Bangladesh.
The first group received no intervention.
The second was invited to childbirth classes.
Mothers in the third had five visits by health workers who had just six weeks of training. They offered iron and folic acid supplements along with advice about cutting the umbilical cord with a sterile blade, keeping the baby warm and breast-feeding. After births, the workers checked babies, diagnosed infections and gave antibiotics or suggested hospital visits.
In the first two groups, neonatal deaths were roughly the same. In the third, they were 34 percent lower.
The authors estimated the cost at $3,000 per life saved.