Why Is Continuum of Care from Home to Health Facilities Essential to Improve Perinatal Survival?
Section snippets
Search Strategy and Studies
We searched PubMed and the Cochrane Controlled Trials Register in the Cochrane Library for randomized controlled trials (RCTs), systematic reviews, meta-analyses, and qualitative reviews. The search strategy included the following groups of keywords connected by “and”: (i) newborn OR neonate OR neonatal OR stillbirth OR stillborn; (ii) community OR home; and (iii) health center OR health facility OR Hospital. We included only studies that had been conducted in countries with a low or middle
Strategies to Improve Linkages Between Homes and Health Facilities
Several community-intervention strategies have the potential to improve the links between home and the health facility. In subsequent sections, we briefly review the evidence for the following 3 approaches:
- 1
home-based care by traditional birth attendants (TBAs) and CHWs;
- 2
community mobilization, particularly a participatory intervention strategy involving women's group meetings; and
- 3
financing strategies to increase demand for health services
Impact of Community-Based Strategies on Neonatal Mortality
There is a growing body of evidence that community-based interventions can reduce neonatal mortality in high-mortality settings with very low access to facility based care.13, 14 The authors of a systematic review identified 60 studies that evaluated training of TBAs, of which 32 had a postcomparison design and 21 had a pre-post design.15 We added the results of a subsequently published RCT of effectiveness of training TBAs conducted in Pakistan to those of the meta-analysis.16 Another
Impact of Community-Based Strategies on Health Facility Utilization
There are 3 possible mechanisms of effect of community-based strategies on neonatal survival. First, the intervention strategy may result in optimal newborn care practices which prevent illness and promote healthy growth and development.13 Second, provision of timely and appropriate care and treatment at or near home could reduce severity of illness. Finally, the impact on mortality could be a result of improved linkages between the homes and health facilities and increased use of health
Lessons from Other Health Programs
The community-facility continuum of care for other childhood illnesses, such as pneumonia, diarrhea and malaria also follows the same pattern, ie, home care, care seeking for illness, management of illness at community or health facility, and emergency triage assessment and treatment, and appropriate management of severely ill children in hospitals. These are part of Integrated Management of Childhood Illness (IMCI), where referral of seriously sick children is important for survival. Children
Gaps in Evidence
The availability of information on the effect of community interventions to improve newborn health has increased significantly in the recent past. As part of this new evidence base are the findings from studies that explored how interventions might increase the use of health care at the facility level. Still, important information gaps remain. Particularly noticeable is the need for data on cost-effectiveness and effectiveness in different settings, particularly in sub-Saharan Africa. Also
Conclusions
Currently, available evidence suggests that the community strategy with the greatest impact on neonatal mortality is home visits by CHWs combined with community mobilization strategies. The same intervention strategy appears to be one of the most effective in increasing health facility use. An equally effective strategy for increasing health facility use seems to be financing health care to remove financial access barriers, particularly using conditional cash transfers or vouchers.
Acknowledgments
We thank Paulson Amibor for his assistance in the literature search.
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Cited by (27)
Neonatal Nursing and Helping Babies Breathe: An Effective Intervention to Decrease Global Neonatal Mortality
2011, Newborn and Infant Nursing ReviewsCitation Excerpt :Each of the major causes of neonatal mortality—prematurity, infection, and asphyxia― leave many survivors with lifelong disabilities or morbidities. Community mobilization and expanded effective services for women and their newly born babies will be necessary for any further progress.11 Helping Babies Breathe (HBB) is a hands-on educational curriculum created specifically for birth attendants in resource-limited settings.
3.6 Million Neonatal Deaths-What Is Progressing and What Is Not?
2010, Seminars in PerinatologyCitation Excerpt :In addition, evidence shows that active case-finding through routine home visits has a major effect on increasing treatment for neonatal sepsis and reducing mortality.63,64 However, in many countries the 6-week postnatal visit is the mother and baby's first interaction with the formal health system after birth.65,66 There is increasing consensus on the need for a clearly defined package of postnatal practices and suitable delivery strategies in varying settings.33
Community-Based Intervention Packages for Improving Perinatal Health in Developing Countries: A Review of the Evidence
2010, Seminars in PerinatologyCitation Excerpt :These studies confirm that Family-Community Care interventions can have a substantial effect on neonatal and perinatal mortality3; however, a mixture of all the service delivery modes, with continuity of care between homes and health facilities is ideal. For example, among the studies in this series, the primary link between care in the home and local health facilities was through referrals of sick newborns, although in some cases community-based activities also helped to promote antenatal care and institutional delivery, as described by Martines et al25 in this Seminars series. In one study, CHWs helped to facilitate transportation to the health facilities.15
Tying up loose threads in delivery of a newborn care package
2011, The Lancet
RB, SQ, and JM are staff members of the World Health Organization. The views expressed in this publication are authors' own and they do not necessarily represent the decisions or the stated policy of the World Health Organization.