KARACHI, Jan 14: A trial carried out in rural Sindh with the support of lady health workers (LHWs) has recorded a significant drop in deaths among newborns.

The remarkable results have been achieved by introducing intensive community counselling and educational outreach on proven life-saving newborn healthcare practices into the National Programme for Family Planning and Primary Care in Matiari district.

The study, “Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster-randomised effectiveness trial”, published in the Lancet today, was carried out by the Aga Khan University’s Division of Women and Child Health in partnership with the health ministry, World Health Organisation (WHO) and Save the Children’s Saving Newborn Lives programme.

The two-year scale-up study (2006 to 2008) differed from previous newborn care studies because it hired no new health workers.

The research study, experts believe, could be very helpful for developing countries, particularly Pakistan. The country currently has one of the highest rates of mortality in South Asia for children younger than five years (94 deaths per 1,000 live births). Over half (57 per cent) of these deaths occur during the newborn period, with most occurring in the first few days after delivery. “This is the first study that shows how simple (and) proven healthcare interventions can be integrated effectively into an existing public health system. That means these kinds of lifesaving results are feasible and sustainable,” says Dr Zulfiqar A. Bhutta, lead author of the Lancet article and professor and chair of Women and Child Health at the AKU.

If implemented across the nation, the simple healthcare practices used in the research trial could save over 90,000 lives a year, according to Dr Bhutta.

The research paper says the intervention package only added six days to the LHWs’ training. The community workers were taught how to provide group counselling on maternal and newborn care practices, to partner with traditional birth attendants (who also received training under the programme), and to make home visits to teach simple newborn care to new mothers, including early and exclusive breastfeeding, delayed bathing and early recognition of signs of serious illnesses.

Voluntary community health committees were set up to facilitate the LHWs. “The health committees played a crucial role in saving the lives of mothers and newborns as they collected funds from locals and arranged transport to attend to emergencies,” research supervisor Dr Shah Mohammad said.

The intervention package was associated with a 15 to 20 per cent reduction in perinatal and newborn mortality. The biggest changes occurred in behaviour related to seeking of antenatal care and in-facility births and there was a 35 per cent increase in the number of deliveries at public sector hospitals, compared to the previous two years.

As many as 60 per cent more mothers breastfed their infants within one hour of birth, and 36 per cent more mothers gave the antibody-rich first breast milk, called colostrum, which is often traditionally discarded.

Also, the number of mothers and their newborns receiving postnatal visits from LHWs registered a nearly three-fold increase, jumping to 28 per cent from a mere eight per cent at the start of the study.