Training in basic care reduces neonatal deaths in developing countries

Training midwives in basic neonatal care reduces infant death in the first seven days of life for babies born in health care facilities in developing countries. It also has the potential for saving more than 1 million lives worldwide each year, according to a study and commentary published in the October issue of Pediatrics.

Ninety-eight percent of the 3.7 million neonatal deaths in the world occur in developing countries. This training project, spearheaded by the study's lead author, Waldemar A. Carlo, M.D., director of the University of Alabama at Birmingham Division of Neonatology and member of the Centre for Infectious Disease Research in Zambia, was designed to train midwives in basic infant care and resuscitation techniques at 18 urban community health clinics in Lusaka and Ndola, Zambia.

Throughout the world, birth asphyxia, low birth weight or prematurity and infections are major causes of death during the seven days after birth, according to Carlo. The low-cost interventions in this study have already been shown to be effective in preventing stillbirth and perinatal deaths in community births, including home births, in a study published earlier this year in the New England Journal of Medicine, of which Carlo was the lead author. The study in Pediatrics was necessary, he says, to show the same results could be replicated in clinic settings.

Using the train-the-trainer model, local instructors trained birth attendants using the World Health Organization (WHO) newborn-care course (routine neonatal care, resuscitation, thermoregulation, breastfeeding, kangaroo care, care of the small baby and common illnesses) and a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (in-depth basic resuscitation).

"The midwives were trained to do several easy steps that are critical for babies to survive at birth and be kept alive through the first week of life," Carlo says. "We selected these courses because previous research has shown they contain the essential interventions necessary to sustain life in many infants and are a cost-effective educational package that can be used anywhere in the world."

 A total of 71,689 neonates were enrolled in the study; after the midwives received training the seven-day mortality decreased from 11.5 deaths per 1,000 births to 6.8 deaths per 1,000 births.  

"The findings show that these two low-cost training programs, whether used in a community or clinic setting, are effective in combating infant mortality in the developing world," Carlo says. "Now we are moving to cost analysis studies to see what resources will be needed to expand the training programs, and we are also following the babies who survived following resuscitation to make sure they are developing well."

Carlo's co-authors on the paper are Elwyn Chomba, M.D., Centre for Infectious Disease Research in Zambia and Department of Pediatrics and Child Health, University Teaching Hospital, University of Zambia, Lusaka, Zambia; Ornella Lincetto, M.D., Department of Child and Adolescent Health, World Health Organization Country Office in Lao People's Democratic Republic; Linda L. Wright, M.D. Center for Research for Mothers and Children, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Md.; and, from RTI International in Durham, N.C., Elizabeth M. McClure, M.Ed.; Hrishikesh Chakraborty, Dr. Ph.; Tyler Hartwell, Ph.D.; and Hillary Harris, M.S.