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Murthy S, Yan SD, Alam S, Kumar A, Rangarajan A, Sawant M, Sulaiman H, Yadav BP, Singh Pathani T, Kumar H G A, Kak S, A M V, Kaur B, N R, Mishra A, Elliott E, Delaney MM, Semrau KEA. Improving neonatal health with family-centered, early postnatal care: A quasi-experimental study in India. PLOS Glob Public Health 2023; 3:e0001240. [PMID: 37228043 DOI: 10.1371/journal.pgph.0001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 04/13/2023] [Indexed: 05/27/2023]
Abstract
Despite the global decline, neonatal mortality rates (NMR) remain high in India. Family members are often responsible for the postpartum care of neonates and mothers. Yet, low health literacy and varied beliefs can lead to poor health outcomes. Postpartum education for family caregivers, may improve the adoption of evidence-based neonatal care and health outcomes. The Care Companion Program (CCP) is a hospital-based, pre-discharge health training session where nurses teach key healthy behaviors to mothers and family members, including skills and an opportunity to practice them in the hospital. We conducted a quasi-experimental study to assess the effect of the CCP sessions on mortality outcomes among families seeking care in 28 public tertiary facilities across 4 Indian states. Neonatal mortality outcomes were reported post-discharge, collected via phone surveys at four weeks postpartum, between October 2018 to February 2020. Risk ratios (RR), adjusting for hospital-level clustering, were calculated by comparing mortality rates before and after CCP implementation. A total of 46,428 families participated in the pre-intervention group and 87,305 in the post-intervention group; 76% of families completed the phone survey. Among the 33,599 newborns born before the CCP implementation, there were 1386 deaths (NMR: 41.3 deaths per 1000 live births). After the intervention began, there were 2021 deaths out of 60,078 newborns born (crude NMR: 33.6 deaths per 1000 live births, RR = 0.82, 95% CI: 0.76, 0.87; cluster-adjusted RR = 0.82, 95% CI: 0.71, 0.94). There may be a substantial benefit to family-centered education in the early postnatal period to reduce neonatal mortality.
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Affiliation(s)
| | - Shirley Du Yan
- Noora Health, San Francisco, California, United States of America
| | - Shahed Alam
- Noora Health, San Francisco, California, United States of America
| | - Amit Kumar
- Data Science, ShriSankhyam Analytics and Research LLP, New Delhi, India
| | - Arjun Rangarajan
- Noora Health, San Francisco, California, United States of America
| | | | | | | | | | | | - Sareen Kak
- Aurora Health Innovations, Bengaluru, India
| | | | - Baljit Kaur
- Department of Health and Family Welfare, Government of Punjab, Chandigarh, India
| | - Rajkumar N
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India
| | - Archana Mishra
- Directorate of Public Health & Family Welfare, National Health Mission, Bhopal, Madhya Pradesh, India
| | - Edith Elliott
- Noora Health, San Francisco, California, United States of America
| | - Megan Marx Delaney
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Katherine E A Semrau
- Ariadne Labs, Harvard T.H. Chan School of Public Health/Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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