NEWHINTS cluster randomised trial to evaluate the impact on neonatal mortality in rural Ghana of routine home visits to provide a package of essential newborn care interventions in the third trimester of pregnancy and the first week of life: trial protocol
NEWHINTS cluster randomised trial to evaluate the impact on neonatal mortality in rural Ghana of routine home visits to provide a package of essential newborn care interventions in the third trimester of pregnancy and the first week of life: trial protocol
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DOI：
10.1186/1745-6215-11-58
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发表时间：
2010-05-17
期刊：
影响因子：
2.5
通讯作者：
Hill, Zelee
中科院分区：
文献类型：
--
作者：
Kirkwood, Betty R.;Manu, Alexander;Hill, Zelee
背景：解决新生儿死亡问题对于实现儿童生存千年发展目标至关重要。新生儿死亡人数略低于400万，占每年5岁以下儿童死亡人数1 080万的38%;其中99%发生在低收入和中等收入国家，这些国家的大部分分娩是在家中进行的，对母亲和新生儿的产后护理要么无法获得，要么质量很差。世卫组织和儿童基金会发表了一项联合声明，呼吁各国政府执行“新生儿家访：提高存活率的战略”，此前在南亚进行了几项研究，通过基于社区的办法大幅降低了新生儿死亡率。然而，尚未在非洲对这些方案的可行性和有效性进行评估。Newhints研究的目的是这样做，在加纳，并制定一个可行的和可持续的以社区为基础的方法，以改善新生儿护理的做法，并通过这样做提高新生儿survival.Methods：Newhints是一个综合干预包的基础上广泛的形成性研究，并与七个区卫生管理小组（DHMTs）在布朗阿哈福地区的密切合作。其核心内容是培训现有的社区监测志愿者，以识别孕妇，并在怀孕期间进行两次家访，在出生后第一周进行三次家访，以解决基本护理问题，并评估和转介出生体重极低和患病的婴儿。CBSV得到一系列材料、定期监督访问、激励措施、与传统助产士、卫生设施工作人员和社区的宣传活动以及在卫生设施提供基本新生儿护理培训的支持。这些集群是98个监督区; 49个被随机分配用于实施纽因茨干预，其他49个作为对照。将通过对7个区的育龄妇女进行监测，从大约15 000名婴儿中收集关于新生儿死亡率和护理做法的数据。详细的过程、成本和成本效益评价也正在进行之中。
Background: Tackling neonatal mortality is essential for the achievement of the child survival millennium development goal. There are just under 4 million neonatal deaths, accounting for 38% of the 10.8 million deaths among children younger than 5 years of age taking place each year; 99% of these occur in low- and middle-income countries where a large proportion of births take place at home, and where postnatal care for mothers and neonates is either not available or is of poor quality. WHO and UNICEF have issued a joint statement calling for governments to implement "Home visits for the newborn child: a strategy to improve survival", following several studies in South Asia which achieved substantial reductions in neonatal mortality through community-based approaches. However, their feasibility and effectiveness have not yet been evaluated in Africa. The Newhints study aims to do this in Ghana and to develop a feasible and sustainable community-based approach to improve newborn care practices, and by so doing improve neonatal survival.Methods: Newhints is an integrated intervention package based on extensive formative research, and developed in close collaboration with seven District Health Management Teams (DHMTs) in Brong Ahafo Region. The core component is training the existing community based surveillance volunteers (CBSVs) to identify pregnant women and to conduct two home visits during pregnancy and three in the first week of life to address essential care practices, and to assess and refer very low birth weight and sick babies. CBSVs are supported by a set of materials, regular supervisory visits, incentives, sensitisation activities with TBAs, health facility staff and communities, and providing training for essential newborn care in health facilities.Newhints is being evaluated through a cluster randomised controlled trial, and intention to treat analyses. The clusters are 98 supervisory zones; 49 have been randomised for implementation of the Newhints intervention, with the other 49 acting as controls. Data on neonatal mortality and care practices will be collected from approximately 15,000 babies through surveillance of women of child-bearing age in the 7 districts. Detailed process, cost and cost-effectiveness evaluations are also being carried out.