250057 Role of village level education and utilization of existing facilities in reducing neonatal mortality in rural India and evaluation of post-study sustainability and impact of new parallel programs

Tuesday, November 1, 2011: 1:42 PM

Pinaki Panigrahi, MD, PhD , Center for Global health and Development, Depts. of Epidemiology & Pediatrics, Colloge of Public Health, University of Nebraska Medical Center, Omaha, NE
Ashish Joshi, MD, MPH , Center for Global Health and Development, Department of Health Services Research Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE
Hegang Chen, PhD , Department of Epidemiology & Preventive Medicine, Division of Biistatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, MD
Dinesh Chandel, PhD , Center for Global Health and Development, Dept. of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE
Radhanath Satpathy, MD , Department of Pediatrics, Ispat General Hospital, Rourkela, India
Nimai Nanda, MD , Department of Pediatrics, Ispat General Hospital, Rourkela, India
Lingaraj Pradhan, MD , Department of Pediatrics, Capital Hospital Bhubaneswar, Bhubaneswar, India
Shubhranshu Mohapatra, MD , Department of Epidemiology, Asian Institute of Public Health, Bhubaneswar, India
Sailajanandan Parida, MD , Department of Pediatrics, SCB Medical College, Cuttack, India
Ira Gewolb, MD , Department of Pediatrics & Human Development, Michigan State University College of Medicine, Lansing, MI
J. Glenn Morris Jr., MD, MPH, TM , Emerging Pathogens Institute, University of Florida, Gainesville, FL
Introduction: India accounts for one third of the five million neonatal deaths in the world, 40% of which die due to sepsis. Methods: Anganwadi workers (AWWs) in rural Orissa, India, were trained using a one-day module on signs/symptoms of neonatal sepsis. AWWs visited infants daily for the first 60 days of life and referred infants with suspect sepsis to nearby hospitals for treatment. Neonatal, maternal variables, and sites were adjusted and deaths examined as an outcome in 257 study and similar number of control villages. A pre-intervention year was compared with two consecutive post-intervention years until study closure. Data collection was continued for three more years to examine sustainability, followed by an additional two years (total 5 years post-study) when two new village level programs/workers were introduced in the same area. Results: While there was a decline in both neonatal and post-neonatal deaths in second year compared to first pre-intervention year, there was a significant reduction (p=0.001) in year three. NMR reduced from 40 per thousand in year one to 32 in year two and 28 in year three in study villages. NMR in post-study years were 21, 23, and 25 in the tribal area demonstrating sustainable effectiveness of the education after the study period. NMR was 23 after introduction of two additional maternal and child health programs employing temporary ASHA and Yashoda female workers. Conclusions: A significant and sustainable reduction in neonatal mortality can be attained by village level education without additional human resources or infrastructure in rural India.

Learning Areas:
Assessment of individual and community needs for health education
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Protection of the public in relation to communicable diseases including prevention or control
Public health or related education

Learning Objectives:
Examine the impact of educating lay workers on reducing neonatal sepsis related deaths in a developing country setting. Compare sustainability of neonatal mortality reduction after study closure Compare the impact of other parallel (new) programs during the follow-up year.

Keywords: Community-Based Public Health, Child Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: MD,PhD. Molecular epidemiology and surveillance of pediatric infectious diseases; Principal Investigator on NIH grants to conduct Neonatal sepsis surveillance and prevention of Newborn infections in a community setting.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.