The number of newborn deaths can be reduced by developing the capacity of mothers and fathers, and by training government Lady Health Workers (LHWs) serving communities. These findings, of a five-year-long Hala Perinatal and Newborn Care Project in the Matiari District of Sindh , conducted by a team headed by Dr Zulfiqar Bhutta, Professor and Chairman of the Department of Paediatrics and Child Health at Aga Khan University (AKU), were announced at a ceremony held at local hotel in Karachi on December 20, 2008. Save the Children, an international organisation committed to improving the lives of children in need, collaborated with the University on the study. The Federal Minister for Health, Aijaz Hussain Jhakhrani, was the chief guest at the event.
According to the Pakistan Demographic and Health Survey, one in every 11 children in Pakistan dies before the age of five, and more than half of these deaths occur during the first month of life. Despite past efforts and the availability of almost 100,000 trained government LHWs , there have been few studies to evaluate the effectiveness of these health care workers in addressing perinatal and newborn care in the rural areas of Pakistan . “Even though infant mortality has decreased over the last three decades, newborn mortality has remained constant. This is because child survival programmes have mostly focused on preventing pneumonia, diarrhoea and vaccine preventable diseases, which are important causes of infant deaths, but not in the first month of life,” said Dr Amanullah Khan, Director of Health for Save the Children's Pakistan Country Office.
The Hala study was design ed to evaluate the effectiveness of a community-based package of interventions, carried out by LHWs trained by the National Programme for Family Planning and Primary Health Care , in collaboration with AKU, to improve delivery conditions and reduce neonatal mortality in ordinary health system settings. The interventions were two-pronged. One aspect focused on training LHWs in briefing mothers about simple newborn health care measures; and the second, on setting up community health committees to educate fathers about health care for the family, especially for mothers and newborn babies. “The majority of births, three out of four, in the country are taking place at home, in the hands of unskilled birth attendants, under unhygienic conditions, which puts the lives of both mothers and newborns at risk. Simple changes, such as ensuring the child is not bathed immediately after birth, can help prevent hypothermia, which is one of the leading causing of neonatal deaths,” said Dr Bhutta.
The results revealed that through community-based interventions, mothers feeding their babies colostrum – the immune-boosting breast milk produced for a few days after birth –increased from 46 per cent to 95 per cent. Additionally, delaying newborn bathing increased from 26 per cent to 57 per cent. The proportion of home births, generally conducted under unhygienic conditions, decreased from 53 per cent to 32 per cent, while births at health care institutions increased from 40 per cent to 67 per cent. The result was a substantial reduction in the overall rate of still births and neonatal mortality in the areas with LHW involvement. “ The findings suggest that interventions at the basic community level are highly effective in reducing neonatal mortality. They show that with the help of the government's LHW programme, such measures can be used in other districts of Pakistan to reduce the unacceptable burden of newborn deaths,” said Dr Bhutta. He also spoke about a similar upcoming research project in Naushero Feroze, which will evaluate the effectiveness of LHWs in preventing and treating birth asphyxia – when a baby does not receive enough oxygen before, during or just after birth – and infections among newborns.
Minister Aijaz Hussain Jakhrani stated that child health has been a major area of concern for the Ministry of Health and the results of the Hala Perinatal Project can be scaled up using sustainable strategies. He said that such low-cost programmes, which can be effectively implemented within the framework of the existing health care system, can be used in other districts of the country as well.
The event was attended by members of the Ministry of Health's National Programme for Family Planning and Primary Health Care, health Executive District Officers, paediatricians from the Pakistan Paediatrics Association, heads of Paediatric Department of Civil and Jinnah Hospitals, students, health care professionals and representatives from various national and international agencies.