Newborn Thermal Care Practices in Rural India: Community-based Program to Prevent and Improve Recognition and Management of Hypothermia

This study utilizes a community-driven health education program using Community Health Workers and Community Volunteers to promote effective domiciliary essential newborn care practices through community mobilization and behavior change communications in a population of 110,000 in rural Uttar Pradesh, India. 

A collaboration between JHSPH, Save the Children (Saving Newborn Lives) and INCLEN, the trial evaluated the cost-effectiveness of behavior change communications and use of a newborn body temperature indicator (ThermoSpot) on neonatal mortality and morbidity, including hypothermia incidence recognition and management; care-seeking; equity; and cost-effectiveness.

Study Objectives:

• Determine domiciliary care knowledge, attitudes and practices regarding essential newborn care, with a focus on newborn thermal control.
• Develop behavior change communications to promote prevention, early recognition and effective management of newborn hypothermia.
• Evaluate impact and cost-effectiveness of behavior change communications delivered by Community Health Workers and Promoters/Change Agents on essential newborn care practices, including care-seeking; prevalence, recognition and management of hypothermia, including adaptation, safety and utility of Kangaroo Mother Care; and neonatal morbidity and mortality.
• Evaluate the feasibility and acceptability of using LCT ThermoSpot device in rural communities to enhance mothers’ recognition and management of neonatal hypothermia.
• Determine the influence of the neonatal hypothermia indicator (ThermoSpot) on recognition of and response to newborn hypothermia.
• Develop algorithms for recognition and management of hypothermia to inform neonatal IMCI and verbal autopsy protocols.
• Gain insight into the potential roles of various cadres of workers in providing neonatal health services at the community level, and inform the development of models of community-based essential newborn care.

Co-Investigators:

• Vishwajeet Kumar (JHSPH)
• Abdullah H. Baqui (JHSPH)
• Mathuram Santosham (JHSPH)
• Peter Winch (JHSPH)
• Saifuddin Ahmed (JHSPH) 
• Shally Awasthi (Chhatrapati Shahuji Maharaj Medical University)
• J.V.Singh (Chhatrapati Shahuji Maharaj Medical University)

Publications

Darmstadt GL, Kumar V, Shearer JC, Misra R, Mohanty S, Baqui AH, Coffey PS, Awasthi S, Singh JV, Santosham M, the Saksham Study Group. Validation of accuracy and community acceptance of the BIRTHweigh III scale for categorizing newborn weight in rural India. J Perinatology 27, 602-608.

Patel Z, Kumar V, Singh P, Singh V, Yadav R, Baqui AH, Santosham M, Awasthi S, Singh JV, Darmstadt GL for the Saksham Study Group. (2007). Feasibility of community neonatal death audits in rural Uttar Pradesh, India. J Perinatol, 27, 556-564.