Several studies in Asia have shown how community efforts can reduce neonatal deaths, and these served as models. Even rarer, however, are rigorous studies on the impact of quality improvement on healthcare in low-income countries.
A way to help poor countries meet UN MDG 4
Malawi has one of the highest maternal and newborn mortality rates in the world. The study's findings could show Malawi and other low-income countries, many in sub-Saharan Africa, how to reduce newborn mortality and meet the United Nation's Millennium Development Goal on child mortality (MDG 4).
"Since we know that many African nations are at risk for not meeting the MDGs on maternal and child health, we have to rethink what is being done and help them develop programmes that work," explains Stephen Thornton, Chief Executive of the Health Foundation and a key architect of the programme.
The MaiKhanda approach - the combinations of two interventions working simultaneously - showed a 22 percent reduction in neonatal mortality. In the last 15 months of the study period, when the programme was fully operating, a 30 percent reduction in newborn mortality was reported.
Other findings include a 16 percent reduction in perinatal (the period immediately before and after birth) mortality in areas that received only the community-based intervention, and a 30 percent reduction in late neonatal mortality in areas where interventions were made to improve quality of care in clinics and hospitals.
Evaluating the project proved challenging. Volunteers collected birth and mortality data from 1,900 villages. In total, about 320,000 people, about 10 percent of the population in the three districts, were included in the study to determine the effectiveness of the combined approach.
"Our evaluation adds valuable evidence to the debate over whether it is better to intervene in the facility or in the community," says Tim Colbourn
|Contact: Marshall Hoffman|
Hoffman & Hoffman Worldwide