Full Report - Research for Development - Department for ...

Synthesis results
order to be effective, could not operate in isolation and required continued and
active involvement of healthcare staff in order to review and improve neonatal care
routines.
INCREASING INVESTMENT AND SCALING UP
Three studies considered the impact of increasing investment and scaling up on
infant mortality outcomes. The scaling up of facility-based neonatal care in a district
in southern India showed benefits in perinatal and neonatal mortality (Shantharam
Baliga et al., 2007) (+)/(++). Using a pre- and post-study design, the authors show a
significant decline in early neonatal and perinatal mortality rates, together with a
significant decline in case fatality rates for LBW, sepsis and birth asphyxia. They
noted that, without sufficient community and health worker motivation, the scaling
up was unlikely to have been so successful in reducing early age mortality. Similarly,
Enweronu et al. (2008) (+)/(-) showed the benefits of investment in infrastructural
and staff improvements in neonatal care for the survival of lower birthweight babies
in Ghana. In urban Zambia, Essential Newborn Care training reduced early neonatal
mortality (Chomba et al., 2008) (+)/(++). However, there was a differential impact
of improved service organisation by educational status of the mother, with the
greatest impact among women with no secondary education.
DISCHARGE AND ADMISSION PROCEDURES IN NEONATAL UNITS
Five papers involved the evaluation of improved hospital discharge and admissions
procedures for neonates. Three studies considered this specifically for LBW babies,
albeit with different definitions of LBW. Bhakhoo et al. (1989) (+)/(+) in India,
Bhutta et al. (2004) (+)/(-) in Pakistan and Blencowe et al. (2009) (+)/(+) in Malawi
all suggested that early discharge of neonates was safe and did not lead to an
increase in adverse neonatal mortality outcomes. Among these, the study by
Blencowe et al. (2009) (+)/(+) looked at the early discharge with Kangaroo Mother
Care (KMC) as an alternative to routine hospitalisation of low-birthweight babies.
The study suggested that early discharge was safe and feasible and that, if rolled out
to all levels of health facilities, Kangaroo Mother Care might help to overcome
existing problems in access to care. Agarwal et al. (2007b) also looked early
discharge and rational admissions among other low-cost interventions in a resourcelimited
teaching hospital in India. The findings of the study suggested that simple
interventions such as these could result in a significant decline of neonatal
mortality.
In an Indian-based study, Sasidharan et al. (2005) (-)/(-) looked wider than
admissions and discharges and considered the impact of changed practices in terms
of maternal and newborn contact for high-risk neonates in a hospital newborn unit.
Prior to the intervention, mothers and their newborns were physically separated,
with only occasional breastfeeding permitted. The intervention changed this regime,
and permitted mothers (or their substitutes) to breastfeed on demand, alongside
other service changes. This can be categorised as a low-cost intervention where
increased maternal involvement in the neonatal period proved to be successful in
reducing neonatal mortality.
KANGAROO MOTHER CARE
A total of six studies specifically addressed Kangaroo Mother Care (KMC), which is a
method of care for preterm infants usually involving the infant being carried by the
mother, with skin to skin contact (World Health Organization, 2003). The study by
Colonna et al. (1990) (-)/(-) in urban Mozambique recommended KMC as a low-cost
effective intervention. Three other papers were specifically on KMC as a method of
infant care rather than simply service reorganisation. Whilst Lincetto et al. (2000)
reported significant reductions in neonatal mortality following the introduction of
KMC in a low-resource setting in Mozambique, evidence from the other studies was
What are the effects of different models of delivery for improving maternal and infant health
outcomes for poor people in urban areas in low income and lower middle income countries? 37