A comprehensive review of the evidence regarding the effectiveness of community-based primary healthcare in improving maternal, neonatal and child health: Neonatal health findings

Tags: Poster
Sacks E1, Sakyi K1, Freeman P2, Perry H1
1Johns Hopkins University, 2University of Washington

Background: Lack of access to safe delivery care, emergency obstetric care and postnatal care continue to be challenges for reducing neonatal mortality. This poster reviews the available evidence regarding the effectiveness of community-based primary health care (CBPHC) and necessary conditions for effectiveness in improving health during the first 28 days of life.

Methods A database comprising evidence of the effectiveness of projects, programmes and field research studies in improving maternal, neonatal and child health through CBPHC has been assembled (Gates Funded). From this larger database (N=354), a subset was created from assessments relating to newborn health (N=88). Assessments were excluded if the project beneficiaries were more than 28 days of age, or if the assessment did not identify 1 of the following outcomes related to neonatal health: changes in knowledge about newborn illness, care seeking for newborn illness, utilisation of postnatal care, nutritional status of neonates, neonatal morbidity, or neonatal mortality. An equity assessment was also conducted on the articles in the dataset related to neonatal health.

Results: There is extensive evidence that CBPHC can be effective in improving neonatal health, and we present information about the common characteristics of effective programmes. Twice as many reported an improvement in neonatal health as did those that reported no effect and only 2 reported a negative effect. Many of the neonatal projects assessed in our database utilised community health workers, home visits, and participatory women’s groups. Many of the interventions used in these projects focused on health education (recognition of danger signs), including promotion of exclusive breastfeeding. Almost all of the assessments that included an equity component showed that CBPHC produced neonatal health benefits that favoured the poorest segment of the project population. However, the studies were quite biased in geographic scope, with more than half conducted in South Asia, and many were pilots rather than at scale. Further research on this topic is needed in Africa and Latin America, as well as in urban and peri-urban areas.