Podcast: Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries

Poor health is a common problem for many newborn babies in low-resource settings. One way to help with this might be through the delivery of educational care packages to mothers and communities, and a new Cochrane review from November 2019 looked at the evidence for these. We asked lead author Zohra Lassi from the Robinson Research Institute at the University of Adelaide in Australia to take us through the findings of the review.

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Monaz: Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Poor health is a common problem for many newborn babies in low-resource settings. One way to help with this might be through the delivery of educational care packages to mothers and communities, and a new Cochrane review from November 2019 looked at the evidence for these. We asked lead author Zohra Lassi from the Robinson Research Institute at the University of Adelaide in Australia to take us through the findings of the review.

Zohra: In low and middle-income countries, the use of health services tends to be very low, while deaths and illnesses among newborn babies are very high. Around the world, approximately two and a half million babies die within the first month of birth, with a million dying on the first day and a second million dying over the next six days. Most of these deaths occur in poor countries and most are preventable. 
One way to help might be to provide health education to mothers and family members, and our review suggests that this is worthwhile and can improve access to health care and reduce deaths and illnesses among babies. 
After searching widely, we found a total of 33 experimental studies, which included studies from Africa and Central and South America, but with most coming from Asia, specifically India, Pakistan and Bangladesh. Of the 33 community educational interventions that had been tested, 16 involved family members, most frequently the mother-in-law or the expectant father. Looking at how the education was delivered, 14 studies used one-to-one counselling between a range of community healthcare workers and mothers, and 12 involved group counselling, which consisted predominantly of mothers, with family members included occasionally. The remaining seven studies used a mixture of one-to-one and group counselling.
Turning to the results, we found that community health educational interventions significantly reduced overall newborn death by 13%, with early newborn mortality falling by 26% and late newborn mortality by 45%. The interventions also increased use of any antenatal care during pregnancy by 16%, and the number of women initiating breastfeeding within an hour after birth rose by 56%. 
The greatest impact was seen with educational interventions delivered to both mothers and other family members in a group setting. Educational interventions delivered during antenatal care were more effective for reducing early neonatal deaths, and those delivered during both antenatal and postnatal periods were more effective for reducing late neonatal deaths. Educational interventions during the postnatal period were most effective for improving breastfeeding practices.
In summary, our review offers encouraging evidence on the value of integrating packages of interventions with educational components for mothers and family members in low- and middle-countries. These can be delivered by a range of community workers in group settings and should reduce the number of babies dying in the first days and weeks after birth.

Monaz: If you would like to find out more about the detailed results of the review, and the content of the educational packages that have been studied, the review is available online at Cochrane Library dot com. Just go to the website and search 'community-based maternal educational care packages' to find it.

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