ENC training reduces perinatal mortality in Karnataka, India
Shivaprasad S Goudar1, Sangappa M Dhaded, Elizabeth M McClure
1Jawaharlal Nehru Medical College, Belgaum, India. sgoudar@jnmc.edu
Summary
Essential Newborn Care (ENC) training significantly reduced perinatal mortality in rural India. Neonatal Resuscitation Program (NRP) training did not offer further benefits, highlighting ENC
Area of Science:
- Global health
- Maternal and child health
- Public health interventions
Background:
- Perinatal mortality remains a significant challenge in low-resource settings, particularly in rural India.
- Existing training programs aim to improve neonatal outcomes but require evaluation for effectiveness.
Purpose of the Study:
- To assess the impact of World Health Organization Essential Newborn Care (ENC) training and American Academy of Pediatrics Neonatal Resuscitation Program (NRP) training on perinatal mortality in rural India.
Main Methods:
- A prospective, community-based cluster randomized controlled trial was conducted in 26 communities in Karnataka, India.
- Neonatal outcomes, including mortality at birth, 7 days, and 28 days, were tracked for over 25,000 births.
- A pre-post design evaluated ENC training, followed by randomization to NRP or refresher ENC training.
Main Results:
- Perinatal mortality (infants ≥500 g) decreased from 52 to 36/1000 after ENC training (RR 0.7; 95% CI 0.5, 0.9).
- Stillbirth rates declined from 23 to 14/1000 (RR 0.62; 95% CI 0.46, 0.83), and early neonatal mortality from 29 to 22/1000 (RR 0.74; 95% CI 0.53, 1.03).
- Additional neonatal resuscitation training did not yield further reductions in mortality.
Conclusions:
- WHO Essential Newborn Care community birth attendant training significantly reduced perinatal mortality in a pre-post analysis.
- The ENC training package is an effective intervention for decreasing perinatal mortality in low-resource settings.
