About The Gazette Search Back Issues Contact Us    
The newspaper of The Johns Hopkins University October 6, 2008 | Vol. 38 No. 6
Neonatal Mortality Halved By Community-Based Behavior Change

By Tim Parsons
Bloomberg School of Public Health

A community-based program that reinforces basic childbirth and newborn care practices can reduce a baby's risk of death within the first month of life by as much as 54 percent, according to a study in rural India led by researchers at the Johns Hopkins Bloomberg School of Public Health in collaboration with CSM Medical University in Lucknow, India. The study is published in the Sept. 27 issue of The Lancet.

"Changes in behavior such as preparing for the birth and skin-to-skin care to keep the baby warm, breastfeeding and infection prevention practices were found to significantly reduce neonatal mortality," said Gary Dramstadt, the senior author and principal investigator of the study, who led the research while at the Bloomberg School and is now senior program officer for neonatal health with the Bill & Melinda Gates Foundation.

Vishwajeet Kumar, a researcher in the Bloomberg School's Department of International Health and first author and co-principal investigator of the study, said, "This was a unique experiment that tested a delivery model of preventive practices co-developed with community members. This was essentially a community-driven program that aimed to empower them to save the lives of their own babies."

The randomized trial was conducted in Uttar Pradesh, a state where 25 percent of India's 1 million annual neonate deaths occur. More than 80 percent of infant deliveries took place in the home and away from the formal health care system. As part of the study, the researchers worked with community members to develop simple, culturally relevant messages to reinforce healthy birth preparedness and clean delivery, hygienic umbilical cord care, skin-to-skin care (holding the baby close against the mother's chest), breastfeeding and keeping the baby warm.

Community health workers, with support from community volunteers, worked with pregnant women, their family members and key community members through a series of home visits and community meetings. The behavior-change messages were incorporated by the community into traditional folk songs, which served to further promote the practices and change social norms.

Compared to a control group that received the basic governmental and nongovernmental organization services offered in the region, villages that received the intervention saw a 54 percent reduction in infant deaths during the first month following birth. A second group, which received the same intervention plus a liquid crystal hypothermia indicator to help monitor the baby's temperature, had a 52 percent reduction in neonatal deaths.

Robert Black, co-author of the study and chair of the Bloomberg School's Department of International Health, said, "This study adds to a growing body of evidence that community engagement to ensure the survival of newborns and acceptance of specific changes in care practices can substantially reduce mortality in the very vulnerable first month of life."

Funding was provided by USAID and Save the Children-USA through a grant from the Bill & Melinda Gates Foundation.


The Gazette | The Johns Hopkins University | Suite 540 | 901 S. Bond St. | Baltimore, MD 21231 | 443-287-9900 |