Home-based counselling did not improve neonatal survival

Implementing a home-based volunteer counselling strategy during pregnancy and the first few days of an infant’s life is probably not enough to improve neonatal survival in rural Africa, shows a novel study published in the journal PLOS Medicine by researchers from Karolinska Institutet and the London School of Hygiene & Tropical Medicine, UK. According to the research team, their findings points to the necessity of improving quality of facility-based care of pregnant women and newborn babies in the areas concerned.

The authors of the current study conducted a large cluster-randomized trial in rural Tanzania, which aimed to test whether improvements in neonatal mortality could be achieved by training 824 female volunteers to deliver key counselling messages (including messages about hand washing with soap before delivery and early and exclusive breast feeding) and supporting messages such as the importance of childbirth in a health care facility during three home visits. The study was conducted between 2007 and 2013 in six districts in rural southern Tanzania that covered a population of 1.2 million people.

The study results show that neonatal mortality reduced from 35 to 31 deaths per 1,000 live births in areas where the volunteers were active with 59% of women receiving at least one volunteer visit during pregnancy and 41% received at least one visit postpartum. However, in control wards where volunteers were not making visits neonatal mortality also reduced from 35 to 30 deaths per 1,000 live births during the study. Given similar reduction in both arms of the trial there was no evidence of an impact of the intervention on neonatal survival.

“Despite moderate increases in newborn care behaviours associated with the intervention, neonatal mortality was similar in intervention and comparison areas, questioning the evidence base in support of home-based counselling, says Claudia Hanson, PhD, lead author of the study and affiliated to both Karolinska Institutet, and the London School of Hygiene & Tropical Medicine.

Facility delivery improved dramatically

Although the study did not find that the intervention had an effect on the study’s primary outcome, the newborn care practices reported by mothers were better in intervention compared to comparison areas, including immediate breastfeeding (42% vs 35%), feeding only breast milk for the first 3 days (90% vs 79%), and having clean hands for home delivery (92% vs 88%). Facility delivery improved dramatically in both groups from 41% to 82% and 75% in intervention and comparison wards, respectively, at the end of the study.

“The lack of effect of home-based counselling on neonatal mortality despite improvements in newborn care practices, suggests that improvement in the quality of facility care is of highest relevance in this setting,” says Dr Hanson. “Our results support the recent shift to prioritize improvement in quality of facility-based care in Tanzania and other areas alike in low-income countries.”

Researchers from the following organization have also been involved in the study work: Ifakara Health Institute, Tanzania; ILS Brothers, Tanzania; Commission for Science and Technology, Tanzania; Institute of Global Health, University College London, Storbritannien; Swiss Tropical & Public Health Institute, Schweiz. The study received funding from Bill & Melinda Gates Foundation through a grant by Save the Children. This news article is an edited version of a press release from PLOS Medicine.

Publication

Effectiveness of a home-based counselling strategy on neonatal care and survival: a cluster-randomised trial in six districts of rural Southern Tanzania
Claudia Hanson, Fatuma Manzi, Elibariki Mkumbo, Kizito Shirima, Suzanne Penfold, Zelee Hill, Donat Shamba, Jennie Jaribu, Yuna Hamisi, Seyi Soremekun, Simon Cousens, Tanya Marchant , Hassan Mshinda, David Schellenberg, Marcel Tanner, Joanna Schellenberg
PLOS Medicine, online 29 September 2015, DOI: 10.1371/journal.pmed.1001881