Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial.

BACKGROUND: In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. METHODS: We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104,123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. FINDINGS: Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0.46 [95% CI 0.35-0.60], p<0.0001) and by 52% in the essential newborn care plus ThermoSpot arm (0.48 [95% CI 0.35-0.66], p<0.0001). INTERPRETATION: A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. FUNDING: USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.

Elective high-frequency oscillatory ventilation in preterm neonates: a preliminary investigation in a developing country.

BACKGROUND: Elective high-frequency oscillatory ventilation (HFOV) in preterm infants is known to be as effective as conventional ventilation in the prevention of bronchopulmonary dysplasia without the risk of increased mortality or brain damage. OBJECTIVE: To document the feasibility and safety of early use of HFOV in preterm neonates with respiratory distress syndrome (RDS) in a resource-limited setting. The primary outcome was survival or death, and the secondary outcome included complication rates observed among the two groups, HFOV and synchronised intermittent mandatory ventilation (SIMV). METHOD: Prospective, single-centre, non-crossover, and case-control design comparing outcome of HFOV with synchronised intermittent mandatory ventilation (SIMV) in preterm neonates with RDS. RESULTS: Preterm infants with RDS and a gestational age of 26-36 weeks were ventilated using either SIMV or HFOV soon after intubation. Twenty-two neonates in the HFOV group and 27 in the SIMV group were considered in the final analysis. Mortality was similar in both the groups for each gestational-age subgroup. There were no statistically significant differences in complication rates between the groups. CONCLUSION: Elective ventilation with HFOV to provide pulmonary support for preterm neonates is feasible in a resource-limited country such as India.

Neurofacilitation of Developmental Reaction (NFDR) approach: a practice framework for integration / modification of early motor behavior (Primitive Reflexes) in Cerebral Palsy.

A Randomized Controlled trial was done on 30 (CP) children of age range 6 mon to 2 y with an objective to see the efficacy of Neurofacilitation of Developmental Reaction (NFDR) approach over Neurodevelopmental Therapy (NDT) for integration / modification of early motor behavior (Primitive Reflexes) in Cerebral Palsy (CP). The baseline evaluation was done for tone, postural reactions and GMFM. The subjects were randomly allocated to two groups. With group A, NFDR and group B, conventional approach (NDT) was used for 3 mon followed by re-evaluation. Between groups analysis was done and p value was found to be significant. It was concluded that NFDR approach is more effective than NDT for integration / modification of early motor behavior in children with CP.