Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan
Background In 2018, Pakistan had the world’s highest neonatal mortality rate. Within Pakistan, most neonatal deaths occur in rural areas where access to health facilities is limited, and robust vital registration systems are lacking. To improve newborn survival, there is a need to better understand...
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doaj-d0c4262eaa3a4f1ea5dd4e5036a3cab62021-09-20T13:59:58ZengTaylor & Francis GroupGlobal Health Action1654-98802020-12-0113110.1080/16549716.2020.18029521802952Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural PakistanJessica Duby0Lisa G. Pell1Shabina Ariff2Amira Khan3Afsah Bhutta4Daniel S. Farrar5Diego G. Bassani6Masawar Hussain7Zulfiqar A. Bhutta8Sajid Soofi9Shaun K. Morris10McGill UniversityThe Hospital for Sick ChildrenThe Aga Khan UniversityThe Hospital for Sick ChildrenThe Hospital for Sick ChildrenThe Hospital for Sick ChildrenThe Hospital for Sick ChildrenThe Aga Khan UniversityThe Hospital for Sick ChildrenThe Aga Khan UniversityThe Hospital for Sick ChildrenBackground In 2018, Pakistan had the world’s highest neonatal mortality rate. Within Pakistan, most neonatal deaths occur in rural areas where access to health facilities is limited, and robust vital registration systems are lacking. To improve newborn survival, there is a need to better understand the causes of neonatal death in high burden settings and engage caregivers in the promotion of newborn health. Objective To describe the causes of neonatal death in a rural area in Pakistan and to estimate the effect of an integrated neonatal care kit (iNCK) on cause-specific neonatal mortality. Methods We analyzed data from a community-based, cluster-randomized controlled trial of 5286 neonates in Rahim Yar Khan (RYK), Punjab, Pakistan between April 2014 and August 2015. In intervention clusters, Lady Health Workers (LHW) delivered the iNCK and education on its use to pregnant women while control clusters received the local standard of care. The iNCK included interventions to prevent and identify signs of infection, identify low birthweight (LBW), and identify and manage hypothermia. Verbal autopsies were attempted for all deaths. The primary outcome was cause-specific neonatal mortality. Results Verbal autopsies were conducted for 84 (57%) of the 147 reported neonatal deaths. The leading causes of death were infection (44%), intrapartum-related complications (26%) and prematurity/LBW (20%). There were no significant differences in neonatal mortality due to prematurity/LBW (RR 0.43; 95% CI 0.15–1.24), infection (RR 1.10; 95% CI 0.58–2.10) or intrapartum-related complications (RR 1.04; 95% CI 0.0.45–2.41) among neonates who died in the intervention arm compared to those who died in the control arm. Conclusion The major causes of neonatal deaths in RYK, Pakistan mirror the global landscape of neonatal deaths. The iNCK did not significantly reduce any cause-specific neonatal mortality.http://dx.doi.org/10.1080/16549716.2020.1802952newborncause of deathverbal autopsycommunity health workerspakistan |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jessica Duby Lisa G. Pell Shabina Ariff Amira Khan Afsah Bhutta Daniel S. Farrar Diego G. Bassani Masawar Hussain Zulfiqar A. Bhutta Sajid Soofi Shaun K. Morris |
spellingShingle |
Jessica Duby Lisa G. Pell Shabina Ariff Amira Khan Afsah Bhutta Daniel S. Farrar Diego G. Bassani Masawar Hussain Zulfiqar A. Bhutta Sajid Soofi Shaun K. Morris Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan Global Health Action newborn cause of death verbal autopsy community health workers pakistan |
author_facet |
Jessica Duby Lisa G. Pell Shabina Ariff Amira Khan Afsah Bhutta Daniel S. Farrar Diego G. Bassani Masawar Hussain Zulfiqar A. Bhutta Sajid Soofi Shaun K. Morris |
author_sort |
Jessica Duby |
title |
Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan |
title_short |
Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan |
title_full |
Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan |
title_fullStr |
Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan |
title_full_unstemmed |
Effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural Pakistan |
title_sort |
effect of an integrated neonatal care kit on cause-specific neonatal mortality in rural pakistan |
publisher |
Taylor & Francis Group |
series |
Global Health Action |
issn |
1654-9880 |
publishDate |
2020-12-01 |
description |
Background In 2018, Pakistan had the world’s highest neonatal mortality rate. Within Pakistan, most neonatal deaths occur in rural areas where access to health facilities is limited, and robust vital registration systems are lacking. To improve newborn survival, there is a need to better understand the causes of neonatal death in high burden settings and engage caregivers in the promotion of newborn health. Objective To describe the causes of neonatal death in a rural area in Pakistan and to estimate the effect of an integrated neonatal care kit (iNCK) on cause-specific neonatal mortality. Methods We analyzed data from a community-based, cluster-randomized controlled trial of 5286 neonates in Rahim Yar Khan (RYK), Punjab, Pakistan between April 2014 and August 2015. In intervention clusters, Lady Health Workers (LHW) delivered the iNCK and education on its use to pregnant women while control clusters received the local standard of care. The iNCK included interventions to prevent and identify signs of infection, identify low birthweight (LBW), and identify and manage hypothermia. Verbal autopsies were attempted for all deaths. The primary outcome was cause-specific neonatal mortality. Results Verbal autopsies were conducted for 84 (57%) of the 147 reported neonatal deaths. The leading causes of death were infection (44%), intrapartum-related complications (26%) and prematurity/LBW (20%). There were no significant differences in neonatal mortality due to prematurity/LBW (RR 0.43; 95% CI 0.15–1.24), infection (RR 1.10; 95% CI 0.58–2.10) or intrapartum-related complications (RR 1.04; 95% CI 0.0.45–2.41) among neonates who died in the intervention arm compared to those who died in the control arm. Conclusion The major causes of neonatal deaths in RYK, Pakistan mirror the global landscape of neonatal deaths. The iNCK did not significantly reduce any cause-specific neonatal mortality. |
topic |
newborn cause of death verbal autopsy community health workers pakistan |
url |
http://dx.doi.org/10.1080/16549716.2020.1802952 |
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