Evaluation Research to Improve Newborn Health and Survival, CARE India

This study aims to evaluate the impact of a basic package of obstetric and neonatal care practices implemented by CARE-India as part of their Integrated Nutrition and Health Program II (INHP). Building on the lessons learned from the Integrated Nutrition and Health Project I (INHP I) in seven Indian states, CARE-India has designed INHP II, which focuses on six technical interventions.

CARE-India aims to implement this program in 100,000 villages across eight states of India by the year 2006. One of the technical interventions is a focused package of newborn care to be implemented at the community level to improve the health and survival of the newborns, including improvements in careseeking for maternal and newborn conditions.

The services and behaviors promoted include: (a) antenatal care, (b) iron-folate supplementation, (c) tetanus toxoid vaccination, (d) maternal nutrition and rest, (e) birth planning, (f) immediate and exclusive breastfeeding, (h) prevention of hypothermia, (i) aseptic cord care, and (j) identification and referral of cases with danger signs for both pregnancy/delivery complications and newborn conditions. First-line community-based health workers provided the services.

The operations research was conducted in two districts of rural Uttar Pradesh, India (population 480,000). A household survey was conducted in January-May 2003, and the intervention began in July 2003. Three adequacy surveys have been conducted during the course of the intervention to provide feedback to CARE-India, government of India, USAID and the other organizations participating in the project. The third adequacy survey was completed in May 2005.

The evaluation suggests that the intervention improved the coverage of visits by community-based workers to pregnant and postpartum women. Improvements in newborn care practices have also been measured. 

Investigators: 

• CARE-India: Usha Kiran, Manish Subharwal, Lovleen Johri, Sitaratna Devi , D Panwar, Deepika Choudhury
• King George's Medical College: Vinod Sreevashtav, Ramesh Ahuja
• JHSPH: Mathuram Santosham, Abdullah H. Baqui, Robert E. Black, Peter Winch, Saifuddin Ahmed, Larry Moulton

Publications:

Baqui A, Williams EK, Rosecrans AM, Agrawal PK, Ahmed S, Darmstadt GL, Kumar V, Kiran U, Panwar D, Ahuja RC, Srivastava VK, Black RE, Santosham M. Impact of an integrated nutrition and health programme on neonatal mortality in rural northern India. Bull World Health Organ. 2008 Oct;86(10):796-804, A.

Williams EK, Hossain MB, Sharma RK, Kumar V, Pandey CM, and Baqui AH (2007). Birth Interval and Risk of Stillbirth or Neonatal Death: Findings from Rural North India [online version, April 27, 2008]. Journal of Tropical Pediatrics, http://dx.doi.org/10.1093/tropej/fmn027

Baqui AH, Williams EK, Darmstadt GL, Kumar V, Kiran TU, Panwar D, Sharma RK, Ahmed S, Sreevasta V, Ahuja R, Santosham M, Black RE. (2007). Newborn Care in Rural Uttar Pradesh, India. Indian Journal of Peridatrics, 74, 3, 241-247.

Santosham M, Black RE. (2007). Evaluation Research to Improve Newborn Health and Survival in the Integrated Health and Nutrition Program (INHP) II Area of CARE/India. Final Report. (January 2006). Baltimore: Johns Hopkins Bloomberg School of Public Health and USAID.

Baqui AH, Darmstadt GL, Williams EK, Kumar V, Kiran TU, Panwar D, Srivasta V, Ahuja R, Black RE, Santosham M. (2006). Rates, timing, and causes of neonatal deaths in rural India: Implications for neonatal interventions. Bulletin of the World Health Organization, 84, 9, 706-13.