Etiology, Prevention and Treatment of Neonatal Infections in the Community, Mirzapur

Despite significant declines in infant and child mortality rates in recent decades, neonatal mortality rates remain unacceptably high. Overall, infections account for about one-third of all neonatal deaths.

While infections are known to cause a substantial number of neonatal deaths, there has not been adequate investigation into causes and patterns of infections in neonates, and no population-based data is available from low-resource settings. Further characterization of infectious patterns will be important to reduce neonatal mortality.

This collaboration among JHSPH, ICDDR,B, Oxford University, Shishu Hospital, and Kumudini Hospital is a cluster randomized, controlled trial in a population of 300,000 in rural Mirzapur, Bangladesh. The study aims to evaluate the impact (mortality, care practices, cost-effectiveness, equity) of a package of maternal and neonatal care practices, including community health education to promote birth preparedness, clean delivery, evidence-based essential newborn care, and prompt care-seeking for illness at a community-based tertiary care center. 

The study also seeks to determine the bacterial and viral agents of serious neonatal infections on a population basis, which will inform the rational development of treatment regimens. The trial will inform the Government of Bangladesh and NGOs of the cost-effectiveness of this model of neonatal health service delivery.

Investigators:

• Abdullah H. Baqui (JHSPH)
• Peter Winch (JHSPH)
• Mathuram Santosham (JHSPH)
• Shams El Arifeen (ICDDR,B) 
• M. Habibur Rahman Seraji (ICDDR,B)
• Ishtiaq Mannan (ICDDR,B)
• Sanwarul Bari (ICDDR,B)
• Derrick Crook (Oxford University)
• Samir K. Saha (Shishu Hospital)
• ASM Nawshad Uddin Ahmed (Kumindini Hospital)

Publications:

Darmstadt GL, Baqui A, Choi Y,  Bari S,  Rahman SM, Mannan I, Nawshad Uddin Ahmed ASM, Saha SK, Rahman R, Chang S, Winch PJ, Black RE, Santosham M & El Arifeen S, for the Bangladesh Projahnmo-2 (Mirzapur) Study Group. Validation of community health workers’ assessment of neonatal illness in rural Bangladesh. Bull World Health Organ. 2009; 87:12–19.

Bari S, Mannan I, Rahman MA, Darmstadt GL, Seraji MHR, Baqui AH, Arifeen SE, Rahman SM, Saha SK, Ahmed A, Ahmed S, Santosham M, Black RE, Winch PJ. Trends in utilization of referral hospital services for care of sick newborns in a community-based intervention in Tangail District, Bangladesh. J of Health Popul Nutr. 2006; Dec; 24(4):519-29.