Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review

• Published in: Bulletin of the World Health Organization 2010-09, Vol.88 (9), p.658-666
• Main Authors: GOGIA, Siddhartha, HARSHPAL SINGH SACHDEV
• Format: Article
• Language: English
• Subjects: Antibiotics; Babies; Biological and medical sciences; Births; Breastfeeding & lactation; Caregivers; Childbirth & labor; Communities; Community health care; Community Health Workers - organization & administration; Community Health Workers - statistics & numerical data; Death; Delivery, Obstetric - methods; Delivery, Obstetric - statistics & numerical data; Developing countries; Developing Countries - statistics & numerical data; Education; General aspects; Health; Health facilities; Health Promotion - organization & administration; Health Promotion - statistics & numerical data; Home Care Services - organization & administration; Home Care Services - statistics & numerical data; Humans; Inclusions; Infant; Infant Care - organization & administration; Infant Care - statistics & numerical data; Infant mortality; Infant Mortality - trends; Infant, Newborn; Infants; Intervention; LDCs; Maternal and infant welfare; Medical profession; Medical sciences; Medical service; Miscellaneous; Mortality; Neonatal care; Packages; Pregnancy; Prenatal care; Prenatal Care - organization & administration; Prenatal Care - statistics & numerical data; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk; Software; South Asia; Stillbirth; Stillbirth - epidemiology; Systematic review; Tetanus; Umbilical cord; Workers
• ISSN: 0042-9686; 1564-0604
• DOI: 10.2471/BLT.09.069369

To determine whether home visits for neonatal care by community health workers can reduce infant and neonatal deaths and stillbirths in resource-limited settings. We conducted a systematic review up to 2008 of controlled trials comparing various intervention packages, one of them being home visits for neonatal care by community health workers. We performed meta-analysis to calculate the pooled risk of outcomes. Five trials, all from south Asia, satisfied the inclusion criteria. The intervention packages included in them comprised antenatal home visits (all trials), home visits during the neonatal period (all trials), home-based treatment for illness (3 trials) and community mobilization efforts (4 trials). Meta-analysis showed a reduced risk of neonatal death (relative risk, RR: 0.62; 95% confidence interval, CI: 0.44-0.87) and stillbirth (RR: 0.76; 95% CI: 0.65-0.89), and a significant improvement in antenatal and neonatal practice indicators (> 1 antenatal check-up, 2 doses of maternal tetanus toxoid, clean umbilical cord care, early breastfeeding and delayed bathing). Only one trial recorded infant deaths (RR: 0.41; 0.30-0.57). Subgroup analyses suggested a greater survival benefit when home visit coverage was ≥ 50% (P