The incidence of morbidities in a cohort of neonates in rural Gadchiroli, India: seasonal and temporal variation and a hypothesis about prevention.

BACKGROUND: The incidence of morbidities among home-cared neonates in rural areas has not been studied. OBJECTIVES: To estimate the incidence of various neonatal morbidities and the associated risk of death in home-cared neonates in rural setting. To estimate the variation in the incidence of neonatal morbidities by season and by day of life. To identify the scope for prevention of morbidities and suggest a hypothesis. STUDY DESIGN: A prospective observational study nested in the first year of the field trial in rural Gadchiroli, India. Trained village health workers in 39 villages observed neonates at the time of birth and in subsequent eight home visits up to 28 days. We diagnosed 20 neonatal morbidities by using clinical definitions. The data were analyzed for the incidence, case fatality, and relative risk of death and for the seasonal and day-wise variation in the incidence of morbidities. RESULTS: We observed total 763 neonates in 1 year. The incidence of morbidities was a mean of 2.2 morbidities per neonate. The case fatality in 13 morbidities was >10%. Only 2.6% neonates were seen or treated by a physician, and 0.4% were hospitalized. Hypothermia, fever, upper respiratory symptoms, umbilical and skin infections, and conjunctivitis showed statistically significant seasonal variation. Although the morbidities were concentrated in the first week of life, new cases continued to appear throughout the neonatal period. Various morbidities showed different distribution of incidence during 1 to 28 days. CONCLUSIONS: A large burden of disease occurs in rural home-cared neonates, and many morbidities are associated with high case fatality. Some morbidities show strong seasonal and day-wise variation in incidence, indicating poor care at home. We hypothesize that changes in practices and better home-based care will prevent the seasonal and temporal increase in morbidities. Some morbidities may not be preventable and will need early detection and treatment. Therefore, frequent home visits by a health worker are necessary to identify sick neonates.

Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India.

BACKGROUND: Neonatal care is not available to most neonates in developing countries because hospitals are inaccessible and costly. We developed a package of home-based neonatal care, including management of sepsis (septicaemia, meningitis, pneumonia), and tested it in the field, with the hypothesis that it would reduce the neonatal mortality rate by at least 25% in 3 years. METHODS: We chose 39 intervention and 47 control villages in the Gadchiroli district in India, collected baseline data for 2 years (1993-95), and then introduced neonatal care in the intervention villages (1995-98). Village health workers trained in neonatal care made home visits and managed birth asphyxia, premature birth or low birthweight, hypothermia, and breast-feeding problems. They diagnosed and treated neonatal sepsis. Assistance by trained traditional birth attendants, health education, and fortnightly supervisory visits were also provided. Other workers recorded all births and deaths in the intervention and the control area (1993-98) to estimate mortality rates. FINDINGS: Population characteristics in the intervention and control areas, and the baseline mortality rates (1993-95) were similar. Baseline (1993-95) neonatal mortality rate in the intervention and the control areas was 62 and 58 per 1000 live births, respectively. In the third year of intervention 93% of neonates received home-based care. Neonatal, infant, and perinatal mortality rates in the intervention area (net percentage reduction) compared with the control area, were 25.5 (62.2%), 38.8 (45.7%), and 47.8 (71.0%), respectively (p<0.001). Case fatality in neonatal sepsis declined from 16.6% (163 cases) before treatment, to 2.8% (71 cases) after treatment by village health workers (p<0.01). Home-based neonatal care cost US$5.3 per neonate, and in 1997-98 such care averted one death (fetal or neonatal) per 18 neonates cared for. INTERPRETATION: Home-based neonatal care, including management of sepsis, is acceptable, feasible, and reduced neonatal and infant mortality by nearly 50% among our malnourished, illiterate, rural study population. Our approach could reduce neonatal mortality substantially in developing countries.

PIP: The article presents the effect of home-based neonatal care and management of sepsis on neonatal mortality in the Gadchiroli district of India. The study responds to the growing need for the reduction of neonatal mortality rate in developing countries. Sample population involved 39 intervention and 47 control villages in the Gadchiroli district. Baseline data for 2 years (1993-95) were collected from these districts. Neonatal care was introduced in the intervention villages in 1995-98, wherein village health workers trained in neonatal care made home visits and managed sepsis and other neonatal problems. Other workers recorded all births and deaths in the intervention and the control area (1993-98) to estimate mortality rates. Findings showed that the net percentage reduction in the third year of intervention for the neonatal mortality rate was 25.5 (62.2%); for the infant mortality rate, 38.8 (45.7%); and for the perinatal mortality rate, 47.8 (71.0%). Case fatality in neonatal sepsis declined from 16.6% before treatment to 2.8% after treatment by village workers (p 0.01). The article concludes that home-based neonatal care, including management of sepsis could reduce neonatal mortality substantially in developing countries.

Modified rapid radiometric method for detection of Mycobacterium tuberculosis from sputum samples.

A modified, simple and radiometric method for early detection of M. tuberculosis from sputum samples has been developed using a biphasic vial system for detection of 14C-CO2 produced by the metabolism of 14C-U-acetate on glycerol-free Lowenstein-Jensen medium (LJM). Of the 84 smear positive sputum samples examined, 85.7% and 86.9% were scored positive by radiometric and visual methods respectively. The detection rates at 1st, 2nd and 3rd week of the test were 53.3%, 60.7% and 82.1% by radiometry and 1.2%, 11.9% and 54.8% by visual methods respectively. The mean detection time was 10.7 days by the radiometric and 21.0 days by the visual method. An average replication time of primary culture from 54 sputum samples was 25.58 +/- 6.92 h (range 10.0-39.1 h).