Just
under four million infants die each year before reaching one
month of age; neonatal deaths now account for 38% of the 10.8
million deaths among children younger than 5 years of age.
Tackling neonatal mortality is essential if the millennium
development goal to reduce by 2015 overall child mortality
by two-thirds from its levels in 1990 is to be achieved. Newhints
is a collaborative trial between the Kintampo Health Research
Centre and the London School of Hygiene and Tropical Medicine,
with funding from Saving newborn Lives, WHO and DfID.
Its aim was to link with the Ghana Health Service to develop
a feasible and sustainable community based approach to improve
newborn care practices and careseeking during pregnancy and
childbirth through routine home-visits by community volunteers,and
by so doing improve neonatal survival.
The
trial is being conducted in 6 contiguous districts with an
area of 12,000km in the central Brong Ahafo Region of rural
Ghana. The area is predominantly rural and has a total population
of approximately 600,000 persons, with more than 100,000 women
of reproductive age. The study area is multi-ethnic and education
levels are low. It is served by 4 district hospitals, and
a small number of additional government health centres and
private facilities. More than 15,000 babies are born within
the area each year; the neonatal mortality rate is about 30
per 1000 live births. About 50% of births occur at home and
these home deliveries account for a large proportion of all
neonatal deaths. A potential cadre of community workers, who
are currently working in the region and whose capacity could
be expanded to include home visits, are Community Based Surveillance
Volunteers (CBSVs); CBSVs currently assist the DHMTs with
the registration of births, disease detection and community
mobilization.
The
Newhints intervention was developed over a 2 year period in
close collaboration with the 6 District Health Management
Teams (DHMTs) of Kintampo North and South, Tain, Nkoranza,
Wenchi and Techiman Districts, all in the Brong Ahafo region
of Ghana, with input from relevant national programme coordinators.
It is an integrated package with several components. The core
component of the Newhints intervention is to train the current
network of community based surveillance volunteers (CBSVs)
to identify pregnant women in the community and to conduct
two home visits during pregnancy and three in the first week
of life of the neonate to address essential maternal and neonatal
care practices, and to assess and refer sick babies. Newhints
also involves strengthening of the DHMTs including developing
a sustainable supervisory and remuneration structure for the
CBSVs and several supportive activities including improving
skills in newborn care in the district hospitals and sensitisation
activities with health facility staff, traditional birth attendants
and communities.
Newhints
will be evaluated through a cluster randomised controlled
trial design. The clusters are 98 Newhints supervisory zones
each comprising about 8-10 CBSVs. The Newhints intervention
is being delivered in half of the Newhints zones chosen at
random in each of the six districts. All pregnant women and
newborn babies in the 49 intervention zones will be the recipients
of the intervention, unless they refuse the home visits by
the CBSVs. Training of all CBSVs in the intervention zones
was completed in June 2008. Evaluation of an impact on newborn
deaths and neonatal care practices will use data collected
through 4-weekly surveillance for all babies born between
1 July 2008 and 30 June 2009. Detailed process evaluations
are also being conducted and cost data are being collected
to enable the cost-effectiveness of Newhints to be assessed.
.
Newhints
presentation
Formative
research findings
The design of the intervention was informed by formative research, the first
step of which was to list the known intervention parameters, information
required to refine the intervention was then identified and a formative
research strategy designed. The strategy included synthesizing available
data, collecting data on newborn care practices in homes and facilities, on
barriers and facilitators to adopting desired behaviors and on practical
issues such as who to include in the intervention. Data collection methods
included a quantitative survey, focus groups, in-depth interviews, shadowing
current volunteers and supervisors and trials of improved practice – a wide
range of respondents were interviewed including recent mothers, traditional
birth attendants and husbands. The data were used to develop an intervention
plan through workshops with national and international stakeholders and
experts. The intervention plan was operationalized by district level
committees. This included developing work plans, a creative brief for the
materials and completing a community volunteer inventory. The intervention
was then piloted and the intervention materials finalized. Throughout the
process literature was reviewed to identify best practice..
Final
report of the formative research
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