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

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.