Levels, timing, and etiology of stillbirths in Sylhet district of Bangladesh.

Background: Lack of data is a critical barrier to addressing the problem of stillbirth in countries with the highest stillbirth burden. Our study objective was to estimate the levels, types, and causes of stillbirth in rural Sylhet district of Bangladesh.

Methods: A complete pregnancy history was taken from all women (n=39 998) who had pregnancy outcomes during 2003-2005 in the study area.

Effect of knowledge of community health workers on essential newborn health care: a study from rural India.

Background: This study explored the relationship between the knowledge of community health workers (CHWs)-anganwadi workers (AWWs) and auxiliary nurse midwives (ANMs)-and their antenatal home visit coverage and effectiveness of the visits, in terms of essential newborn health care practices at the household level in rural India.

Methods: We used data from 302 AWWs and 86 ANMs and data from recently delivered women (RDW) (n=13,023) who were residents of the CHW catchment areas and gave birth to a singleton live baby during 2004-05. Using principal component analysis, knowledge scores for preventive care and danger signs were computed separately for AWWs and ANMs and merged with RDW data.

Setting research priorities to reduce almost one million deaths from birth asphyxia by 2015.

Joy Lawn and colleagues used a systematic process developed by the Child Health Nutrition Research Initiative (CHNRI) to define and rank research options to reduce mortality from intrapartum-related neonatal deaths (birth asphyxia) by the year 2015.

Why is continuum of care from home to health facilities essential to improve perinatal survival?

The period around the time of delivery is extremely hazardous for infants in developing countries. After the first week the risk drops sharply, and survival improves markedly. To reduce perinatal mortality, a continuum of care between the home and the various facilities is essential during pregnancy, childbirth and the newborn period.

Community-based intervention packages for improving perinatal health in developing countries: a review of the evidence.

The Lancet Neonatal Survival Series categorized neonatal health interventions into 3 service delivery modes: "Outreach," "Family-Community Care," and "Facility-based Clinical Care." Family-Community Care services generally have a greater potential impact on neonatal health than Outreach services, with similar costs. Combining interventions from all 3 service delivery modes is ideal for achievement of high impact.

Behavior change for newborn survival in resource-poor community settings: bridging the gap between evidence and impact.

Despite an established evidence base of simple, affordable, and low-cost interventions to avert neonatal deaths, global progress in reducing neonatal mortality has stagnated in recent years. Under-recognition of the critical role played by behavior change in ensuring adoption and dissemination of innovations is a major reason for this gap between evidence and impact. A general lack of understanding of the mechanisms underlying behavior change at a population level coupled with an under-appreciation of the sociocultural context of newborn care behaviors has underscored ill-informed approaches towards behavior change that have met with limited success.

Preventing preterm birth and neonatal mortality: exploring the epidemiology, causes, and interventions.

Globally, each year, an estimated 13 million infants are born before 37 completed weeks of gestation. Complications from these preterm births are the leading cause of neonatal mortality. Preterm birth is directly responsible for an estimated one million neonatal deaths annually and is also an important contributor to child and adult morbidities.

Reducing intrapartum-related neonatal deaths in low- and middle-income countries-what works?

Each year, 814,000 neonatal deaths and 1.02 million stillbirths result from intrapartum-related causes, such as intrauterine hypoxia. Almost all of these deaths are in low- and middle-income countries, where women frequently lack access to quality perinatal care and may delay care-seeking.

Stillbirths: epidemiology, evidence, and priorities for action.

The annual global burden of stillbirths amounts to an estimated 3.2 million%, 98% of which occur in low- and middle-income countries (LMICs). Of these, 1.

Improving the sensitivity of blood culture for Streptococcus pneumoniae.

Isolation of Streptococcus pneumoniae is jeopardized by low sensitivity of blood culture, autolysis and contamination with fast-growing organism(s). We performed an immunochromatographic (ICT) test for S. pneumoniae on chocolatized blood culture bottles and also sub-cultured contaminated bottles on a selective medium, thus identifying an additional eight and three cases, respectively, and improving the detection of pneumococcus by 23% (48% vs.

Neonatal hypothermia and associated risk factors among newborns of southern Nepal.

Background: Neonatal hypothermia is associated with an increased mortality risk for 28 days. There are few community-based data on specific risk factors for neonatal hypothermia. Estimates of association between neonatal hypothermia in the community and risk factors are needed to guide the design of interventions to reduce exposure.

Risk of mortality associated with neonatal hypothermia in southern Nepal.

Objective: To quantify the neonatal mortality/hypothermia relationship and develop evidence-based cutoffs for global definitions of neonatal hypothermia.

Design: Cohort study. Field workers recorded neonatal axillary temperature at home and recorded vital status at 28 days.

"These are not good things for other people to know": how rural Tanzanian women's experiences of pregnancy loss and early neonatal death may impact survey data quality.

Little research in low-income countries has compared the social and cultural ramifications of loss in childbearing, yet the social experience of pregnancy loss and early neonatal death may affect demographers' ability to measure their incidence. Ninety-five qualitative reproductive narratives were collected from 50 women in rural southern Tanzania who had recently suffered infertility, miscarriage, stillbirth or early neonatal death. An additional 31 interviews with new mothers and female elders were used to assess childbearing norms and social consequences of loss in childbearing.

Cost-effectiveness of skin-barrier-enhancing emollients among preterm infants in Bangladesh.

Objective: To evaluate the cost-effectiveness of topical emollients, sunflower seed oil (SSO) and synthetic Aquaphor, versus no treatment, in preventing mortality among hospitalized preterm infants (< 33 weeks gestation) at a tertiary hospital in Bangladesh.

Methods: Evidence from a randomized controlled efficacy trial was evaluated using standard Monte Carlo simulation. Programme costs were obtained from a retrospective review of activities.

Incidence of neonatal hyperbilirubinemia: a population-based prospective study in Pakistan.

Objective: To estimate the incidence of neonatal jaundice and hyperbilirubinemia in a poor urban community in Karachi, where 70% of births occur at home.

Methods: Home-based pregnancy and newborn surveillance were conducted from September 2004 to July 2006 in a multi-ethnic population by trained community health workers. Newborns were visited several times at scheduled intervals until 59 days of life; any baby with jaundice was referred to the local clinic.

Comparing modelled predictions of neonatal mortality impacts using LiST with observed results of community-based intervention trials in South Asia.

Background: There is an increasing body of evidence from trials suggesting that major reductions in neonatal mortality are possible through community-based interventions. Since these trials involve packages of varying content, determining how much of the observed mortality reduction is due to specific interventions is problematic. The Lives Saved Tool (LiST) is designed to facilitate programmatic prioritization by modelling mortality reductions related to increasing coverage of specific interventions which may be combined into packages.

Evaluation of a cluster-randomized controlled trial of a package of community-based maternal and newborn interventions in Mirzapur, Bangladesh.

Background: To evaluate a delivery strategy for newborn interventions in rural Bangladesh.

Methods: A cluster-randomized controlled trial was conducted in Mirzapur, Bangladesh. Twelve unions were randomized to intervention or comparison arm.

Validation of rapid neurodevelopmental assessment instrument for under-two-year-old children in Bangladesh.

Objective: The objective of this study was to determine the reliability and validity of a comprehensive assessment procedure for ascertaining neurodevelopmental status of children aged 0 to 24 months for use by multidisciplinary professionals in a developing country.

Methods: We developed the Rapid Neurodevelopmental Assessment (RNDA) to determine functional status in the following domains: primitive reflexes, gross motor, fine motor, vision, hearing, speech, cognition, behavior, and seizures. Reliability was determined for 50 children who were aged <3 months and 30 children who were aged > or =3 to 24 months and were administered the RNDA by 8 different professionals (3 physicians, 4 therapists, and 1 special teacher).

Clinical signs predicting severe illness in young infants (<60 days) in Bolivia.

Identification of simple signs and symptoms that predict severe illness needing referral for admission of young infants is critical for reducing mortality in developing countries. Infants <2 months of age presenting to two hospitals in La Paz, Bolivia (n=1082) were evaluated by nurses for signs and symptoms, and independently by physicians for the need for admission. In young neonates, sensitivity of individual clinical signs was >35% for measured temperature ≥ 37.

Impact of clean delivery-kit use on newborn umbilical cord and maternal puerperal infections in Egypt.

This cross-sectional cohort study explored the impact of the use of clean delivery-kit (CDK) on morbidity due to newborn umbilical cord and maternal puerperal infections. Kits were distributed from primary-care facilities, and birth attendants received training on kit-use. A nurse visited 334 women during the first week postpartum to administer a structured questionnaire and conduct a physical examination of the neonate and the mother.

Incidence and seasonality of hypothermia among newborns in southern Nepal.

Objective: To quantify incidence, age distribution, and seasonality of neonatal hypothermia among a large population cohort.

Design: Longitudinal cohort study.

Setting: Sarlahi, Nepal.

Household surveillance of severe neonatal illness by community health workers in Mirzapur, Bangladesh: coverage and compliance with referral.

Background: Effective and scalable community-based strategies are needed for identification and management of serious neonatal illness.

Methods: As part of a community-based, cluster-randomized controlled trial of the impact of a package of maternal-neonatal health care, community health workers (CHWs) were trained to conduct household surveillance and to identify and refer sick newborns according to a clinical algorithm. Assessments of newborns by CHWs at home were linked to hospital-based assessments by physicians, and factors impacting referral, referral compliance and outcome were evaluated.