Table 6

Observational, quasi-experimental, and cluster randomized trials of community-based neonatal resuscitation

Author

Country

Study design

Intervention definition

Simultaneous Interventions

Intervention Coverage

Outcomes: Definition

Preterm vs. Intrapartum Death

N (Births)

A = control

B = comparison

Effect Size

RR/OR

(95% CI)


Pratinidhi et al, 1985[50]

Pune, India

Before-and-after

CHW training in basic resuscitation with mouth to mouth

Management of low birth weight, preterm, feeding, illness, cord cutting, feeding, nutrition;

80% of home births received CHW care; 75% of births at home

1) NMR;

2) PMR

Not stated

A) 1444;

B) 1546

1) RR 0.75

2) RR 0.98


Daga SR et al, 1991[51]

Maharashtra, India

Before-and-after, no control

TBA training in basic resuscitation with mouth-to-mouth breathing

Management of low birth weight, hypothermia; transport and referral of high risk babies to hospital

TBAs attended 90% of deliveries

1) NMR;

2) PMR;

3) SBR

Not stated

A) 321;

B) 660

1) RR 0.59 (0.32-1.09);

2) RR 0.39 (0.21-0.69);

3) RR 0.49 (0.16, 1.50)


Kumar R et a; 1998[55]

Haryana, India

Quasi-experimental

Advanced TBA training modern resuscitation with bag mask ventilation and mucus extractor

NS

TBAs delivered 92% of babies at home;

1) Asphyxia mortality (Verbal Autopsy);

2) PMR

Combined "not breathing"

A) 964;

B) 884

1) RR 0.30 (0.11-0.81)

2) RR 0.82 (0.56-1.19)


Bang AT et al 2005[5,72]

Gadichiroli, India

Quasi-experimental

1) 1996-1999: CHW+TBA attend deliveries together, basic resuscitation with tube-mask; 2) 1999-2003: Bag mask. Refresher training every 2 months.

Community treatment of suspected neonatal sepsis, essential newborn care

VHWs attended 84% of deliveries

1) Asphyxia mortality (Verbal autopsy)

2) NMR

3) PMR

4) SBR

5) ENMR

Combined "not breathing" [Failure to breathe at 1, 5 min]

Before-after comparison

A) 763 (95-6);

B) 5510 (96-03)

QE comparison

A)1108

B) 979

1) RR 0.35 (0.15-0.78)a

2) RR 0.41 (0.26-0.66)b

3) RR 0.50 (0.35-0.71)b

4) RR 0.58 (0.36-0.93)b

5) RR 0.44 (0.27-0.73)b


Ariawan I, et al 2006[54]

Cirebon, Indonesia

Before-and-after, no control

Community mid-wife training in resuscitation with tube-mask, refresher training 3, 6, 9 month and VCD refresher video; training in "post-resuscitation" care

Not stated

60% of asphyxia cases managed by midwives; uncertain coverage rate

1) Asphyxia mortality (Verbal autopsy);

2) NMR;

3) SBR

Not stated

A) est 44,000;

B) est 44,000

1) RR 0.39 (0.31-0.48)

2) RR 0.60 (0.53-0.68)

3) RR 0.39 (0.31-0.48)


Carlo W et al 2010[52]

Argentina, DR Congo, Guatemala, India, Pakistan, Zambia

Before-and-after ENC; cluster RCT for NRP training

Training of community birth attendants (TBAs, nurses, midwives, and physicians) in WHO Essential Newborn Care, including basic resuscitation with bag-mask ventilation

Clean delivery, thermal protection, breastfeeding, kangaroo care

78% of births attended by community birth attendant after ENC training

1) PMR

2) SBR

3) ENMR

BW < 1500 g excluded

A) 22,626;

B) 35,017

1) RR 0.85 (0.70-1.02)

2) RR 0.69 (0.54-0.88)

3) RR 0.99 (0.81-1.22)


Gill C et al 2011[53]

Zambia

Cluster RCT

TBA Training in modified neonatal resuscitation program (NRP) w/facemask; competence assessments with refresher trainings every 3-4 mos.

Thermal care, Facilitated referral for presumptive neonatal sepsis (amoxicillin and referral)

Undetermined

1) NMR

2) Day 1 mortality

3) Asphyxia NMR (Verbal autopsy)

4)PMR

Single cause assigned by VA "asphyxia" or "preterm"

A) 1920

B) 1517

1) aRR 0.55, (0.33-0.90)

2) aRR 0.40, (0.19-.83)

3) aRR 0.37 (0.17-0.81)

4) aRR 0.72 (0.51-1.00)


Azad K et al 2011 [73]

Bangladesh

Cluster RCT, factorial design

Intervention arm: TBATraining neonatal resuscitation with bag-valve mask, with subsequent retraining; Control: TBA Training in mouth-to-mouth resuscitation

Intervention and control: Clean delivery, danger signs, emergency preparedness, facility referral. Women's participatory groups in half of clusters

Intervention Coverage: 22% of home deliveries attended by trained TBA; Control 19% by trained TBA

1) ENMR

Not stated

A) 13195

B) 12519

1) 0.95 (0.75-1.21)


a Before-after comparison period 1995-6 versus 1996-2003

b Calculated from data presented in paper for year 3 of intervention (1997-1998) comparing experimental vs. control areas[72]

Lee et al. BMC Public Health 2011 11(Suppl 3):S12   doi:10.1186/1471-2458-11-S3-S12

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