Saving newborn lives with home-based neonatal care: an experience in Gadchiroli, India: community health workers provide a valuable service that has reduced neonatal mortality--a report from Saving Newborn Lives, an initiative of Save the Children.

Worldwide each year, four million babies die before the age of one month; another four million are stillborn. Over 98% of these deaths occur in developing countries, 25% of them in India. Despite improvements in child survival overall, deaths among this age group have declined little, and so represent a growing proportion of all child deaths. Many of these deaths could be prevented by providing appropriate care for pregnant women and timely interventions for newborn babies.

Saving Newborn Lives (SNL), an initiative of Save the Children US, has launched a global programme of newborn and maternal health care designed to address this trend in neonatal mortality.

SEARCH (Society for Education Action and Research in Community Health) in India

The non-profit group, SEARCH, was started by Drs Abhay and Rant Bang in Gadchiroli district, Maharashtra, India, in 1986. Since 2001, SNL has supported a SEARCH project called ANKUR (meaning 'seed') to test whether SEARCH's innovative approach to home-based newborn care (HBNC) can be replicated beyond the original project site. Through SEARCH, HBNC has been expanded to seven other projects in Maharashtra state. including rural, urban slum and tribal sites.

Background to child mortality

SEARCH's first investigations into the extent of newborn mortality (1993-1995) showed that, in this part of India, the infant mortality rate (IMR) was around 70 deaths per 1,000 live births. It had been successfully reduced from 140 per 1,000 in the previous 20 years, owing to vaccination programmes and other interventions to prevent spread of childhood diseases.

However, the fall in mortality levelled out at that stage and it was noted that a significant and disproportionate number of deaths were occurring among the youngest group, those children aged only a few months, and in particular newborn babies in the first week of life.

Focus on neonatal deaths

A study by SEARCH in 13 sites in Maharashtra revealed that 75% of infant deaths were happening during the neonatal period. It became clear that to reduce the IMR further it was necessary to focus on making sure that babies survived the neonatal period.

In Gadchiroli district, further findings from the study were that:

* 95% of women gave birth at home

* 54% of newborns required some medical attention--although only 2.6% received help

* 43% of newborns had low birth weight

* only 38% of mothers could read and write.

Direct causes of neonatal mortality in rural households in...