Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India
Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India
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DOI：
10.1016/s0140-6736(99)03046-9
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发表时间：
1999-12-04
期刊：
影响因子：
168.9
通讯作者：
Deshmukh, MD
中科院分区：
文献类型：
--
作者：
Bang, AT;Bang, RA;Deshmukh, MD
背景：在发展中国家，大多数新生儿无法获得新生儿护理，因为无法进入医院且费用昂贵。我们开发了一套以家庭为基础的新生儿护理，包括败血症（败血症、脑膜炎、肺炎）的管理，并在现场进行了测试，假设它将在3年内将新生儿死亡率降低至少25%。方法在印度Gadchiroli地区选择39个干预村和47个对照村，收集2年（1993- 1995）的基线数据，并在干预村（1995- 1998）引入新生儿护理。接受过新生儿护理培训的乡村卫生院工作人员进行家访，并处理出生窒息、早产或低出生体重、体温过低和母乳喂养问题。他们诊断并治疗新生儿败血症。还提供了训练有素的传统助产士的协助、保健教育和每两周的监督访问。其他工作人员记录了干预区和控制区（1993- 1998年）的所有出生和死亡情况，以估计死亡率。调查结果干预区和控制区的人口特征以及基线死亡率（1993- 1995年）相似。干预地区和对照地区的基线（1993- 1995年）新生儿死亡率分别为每1000例活产62例和58例。在干预的第三年，93%的新生儿接受了家庭护理。与对照组相比，干预区新生儿、婴儿和围产期死亡率（净百分比降低）分别为25.5（62.2%）、38.8（45.7%）和47.8 （71.0%）
Background Neonatal care is not available to most neonates in developing countries because hospitals are inaccessible and costly. We developed a package of home-based neonatal care, including management of sepsis (septicaemia, meningitis, pneumonia), and tested it in the field, with the hypothesis that it would reduce the neonatal mortality rate by at least 25% in 3 years.Methods We chose 39 intervention and 47 control villages in the Gadchiroli district in India, collected baseline data for 2 years (1993-95), and then introduced neonatal care in the intervention villages (1995-98). Village hearth workers trained in neonatal care made home visits and managed birth asphyxia, premature birth or low birthweigbt, hypothermia, and breast-feeding problems. They diagnosed and treated neonatal sepsis. Assistance by trained traditional birth attendants, health education, and fortnightly supervisory visits were also provided. Other workers recorded all births and deaths in the intervention and the control area (1993-98) to estimate mortality rates.Findings Population characteristics in the intervention and control areas, and the baseline mortality rates (1993-95) were similar. Baseline (1993-95) neonatal mortality rate in the intervention and the control areas was 62 and 58 per 1000 live births, respectively. In the third year of intervention 93% of neonates received home-based care. Neonatal, infant, and perinatal mortality rates in the intervention area (net percentage reduction) compared with the control area, were 25.5 (62.2%), 38.8 (45.7%), and 47.8 (71.0%), respectively (p