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A Simple Way to Save Neonates

Abdullah BaquiWhat’s the best way to reduce Bangladesh’s high neonatal mortality rates? Many researchers would target health facilities to improve newborn survival, but Abdullah Baqui looked for simpler strategies closer to home.

Baqui, MBBS, DrPH ’90, MPH ’85, an associate professor of International Health, has worked in India, Nepal and his native Bangladesh since 2000, searching for ways to reduce neonatal deaths.

He notes that Bangladesh has many traditional birth attendants, with little to no training, who provide up to 90 percent of delivery care in rural communities. So he and his fellow researchers recruited local women with no previous training and taught them about maternal and newborn care for six weeks. These community health workers (CHWs) offered a starting point for a pilot program launched with funding from USAID and the Bill & Melinda Gates Foundation.

“In a community you can’t do everything,” Baqui says, “but you can do a lot.” He and his fellow researchers worked with an NGO named Shimantik and the Dhaka-based International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). The researchers spent several months “observing what people do,” he says, “before designing the intervention.”

The resulting intervention first focused on developing “behavior-change messages” for the CHWs and families that showed them how to provide essential newborn care, identify an infant vulnerable to infection, and treat them. Baqui’s team also considered how to deliver the message so that the families would embrace it. He calls this “creating an awareness bridge.” A simple diagnostic tool allowed CHWs to identify infections and treat nearly half of them with injectable antibiotics. They referred urgent cases to facilities, where another third were treated successfully. The interventions also involved working with the Ministry of Health to improve response at primary care facilities.

The result: a community-based initiative that reduced neonatal mortality by a stunning 34 percent in 30 months. Baqui involved community workers in a rigorous evaluation of the program. That study was recognized by The Lancet as Paper of the Year for 2008, one of three so honored.

Baqui is no scene-stealer, and that helped. The locals sensed that they, not an outsider, were making a difference. “We designed this intervention working with local organizations including the Ministry of Health,” he says. “We wanted to involve them in the design, implementation and evaluation, so that there’s a sense of local ownership. That was critical, I believe.”

USAID-Dhaka, excited by the results, authorized $15 million for Jhpiego and Save the Children to adapt the approach elsewhere in Bangladesh. Baqui and his coworkers assisted the ministry in crafting a neonatal strategy that was adopted in March 2009.

Since 2008, Baqui has taken these lessons to countries in Africa. “The interventions are simple and scalable,” he insists, but first you must understand the epidemiology and context of a place. “We [act] on the consensus that this is something good to take to scale,” says Baqui.

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