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