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33. Simple interventions may achieve significant results in birth
outcomes in underdeveloped areas:
Of the world's 4 million annual neonatal deaths, 98% occur in developing
countries. Most perinatal and neonatal deaths occur at home, and many
could be avoided with changes in antenatal, delivery and newborn care
practices. Previous studies in Bolivia and India showed that perinatal
mortality could be reduced from 177 to 44/1000 births (Bolivia) and neonatal
mortality could be reduced by 62% (India) with relatively interventions
that involved participatory intervention with women's groups. In the Indian
study the participatory intervention was combined with additional training
for traditional birth attendants and introduction of a new cadre of supervised
village health workers who visited newborn infants at home, identified
warning signs and managed possible sepsis with antibiotics. These studies
have recently been bolstered by a large scale Nepalese study that randomized
communities into intervention and control clusters and followed up the
response in terms of birth outcome and neonatal and maternal mortality.
In these underdeveloped, underserviced and semi-literate communities,
female education and awareness around pregnancy and childbirth and strategies
to address the issues, achieved significant results in terms of neonatal
and maternal mortality. Women who fell pregnant during the three year
study were more likely to have antenatal care, institutional delivery,
trained birth attendance and hygienic care than were controls. Between
2001 and 2003 the neonatal mortality rate was 26,2 per 1000 in the intervention
clusters vs 36,9 per 1000 in the controls (OR 0,70; 95% CI 0,53 - 0,94).
Maternal mortality was 69 per 100 000 in the study clusters vs 341 per
100 000 in controls (OR 0,22; 95%CI 0,05 - 0,90). At a cost-effectiveness
level the cost per life year saved was $111, well below the World Bank's
$127 which is the recommended threshold for cost-effective interventions.
Read more:
Lancet 2004;364:970-9
Semin Neonatol 1999;4:141-9
Lancet 1999;354:1955-61
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