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Gary L. Darmstadt - One of the best experts on this subject based on the ideXlab platform.
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Neonatal Health program management in a resource‐constrained setting in rural Uttar Pradesh, India
The International journal of health planning and management, 2009Co-Authors: Abigail L Thomas, Vishwajeet Kumar, Mahendra Bhandari, R. C. Ahuja, Pramod K. Singh, Abdullah H. Baqui, Shally Awasthi, J V Singh, Mathuram Santosham, Gary L. DarmstadtAbstract:This analysis identifies salient features of team management that were critical to the efficiency of program implementation and the effectiveness of behavior change management to promote essential newborn care practices in Uttar Pradesh, India. In May 2003, the Johns Hopkins Bloomberg School of Public Health and King George Medical University initiated a cluster-randomized, controlled Neonatal Health research program. In less than 2 years, the trial demonstrated rapid adoption of several evidence-based newborn care practices and a substantial reduction in Neonatal mortality in intervention clusters. Existing literature involving research program management in resource-constrained areas of developing countries is limited and fails to provide models for team organization and empowerment. The Neonatal research project examined in this paper developed a unique management strategy that provides an effective blueprint for future projects. Transferable learning points from the project include emphasizing a common vision, utilizing a live-in field site office, prioritizing character and potential in the hiring process, implementing a learning-by-doing training program, creating tiers of staff recognition, encouraging staff autonomy, ensuring a broad staff knowledge base to seamlessly handle absences, and maintaining the flexibility to change partnerships or strategies.
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Impact of packaged interventions on Neonatal Health: a review of the evidence
Health policy and planning, 2007Co-Authors: Rachel A Haws, Abigail L Thomas, Zulfiqar A Bhutta, Gary L. DarmstadtAbstract:A disproportionate burden of infant and under-five childhood mortality occurs during the Neonatal period, usually within a few days of birth and against a backdrop of socio-economic deprivation in developing countries. To guide programmes aimed at averting these 4 million annual deaths, recent reviews have evaluated the efficacy and cost-effectiveness of individual interventions during the antenatal, intrapartum and postnatal periods in reducing Neonatal mortality, and packages of interventions have been proposed for wide-scale implementation. However, no systematic review of the empirical data on packages of interventions, including consideration of community-based intervention packages, has yet been performed. To address this gap, we reviewed peer-reviewed journals and grey literature to evaluate the content, impact, efficacy (implementation under ideal circumstances), effectiveness (implementation within Health systems), type of provider, and cost of packages of interventions reporting Neonatal Health outcomes. Studies employing more than one biologically plausible Neonatal Health intervention (i.e. package) and reporting Neonatal morbidity or mortality outcomes were included. Studies were ordered by study design and mortality stratum, and their component interventions classified by time period of delivery and service delivery mode. We found 41 studies that implemented packages of interventions and reported Neonatal Health outcomes, including 19 randomized controlled trials. True effectiveness trials conducted at scale in Health systems were completely lacking. No study targeted women prior to conception, antenatal interventions were largely micronutrient supplementation studies, and intrapartum interventions were limited principally to clean delivery. Few studies approximated complete packages recommended in The Lancet’s Neonatal Survival Series. Interventions appeared largely bundled out of convenience or funding requirements, rather than based on anticipated synergistic effects, like service delivery mode or cost-effectiveness. Only two studies reported cost-effectiveness data. The evidence base for the impact of Neonatal Health intervention packages is a weak foundation for guiding effective implementation of public Health programmes addressing Neonatal Health. Significant investment in effectiveness trials carefully tailored to local Health needs and conducted at scale in developing countries is required.
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Safety and impact of chlorhexidine antisepsis interventions for improving Neonatal Health in developing countries.
The Pediatric infectious disease journal, 2006Co-Authors: Luke C. Mullany, Gary L. Darmstadt, James M. TielschAbstract:Affordable, efficacious, and safe interventions to prevent infections and improve Neonatal survival in low-resource settings are needed. Chlorhexidine is a broad-spectrum antiseptic that has been used extensively for many decades in hospital and other clinical settings. It has also been given as maternal vaginal lavage, full-body newborn skin cleansing, and/or umbilical cord cleansing to prevent infection in neonates. Recent evidence suggests that these chlorhexidine interventions may have significant public Health impact on the burden of Neonatal infection and mortality in developing countries. This review examines the available data from randomized and nonrandomized studies of chlorhexidine cleansing, with a primary focus on potential uses in low-resource settings. Safety issues related to chlorhexidine use in newborns are reviewed, and future research priorities for chlorhexidine interventions for Neonatal Health in developing countries are discussed. We conclude that maternal vaginal cleansing combined with newborn skin cleansing could reduce Neonatal infections and mortality in hospitals of sub-Saharan Africa, but the individual impact of these interventions must be determined, particularly in community settings. There is evidence for a protective benefit of newborn skin and umbilical cord cleansing with chlorhexidine in the community in south Asia. Effectiveness trials in that region are required to address the feasibility of community-based delivery methods such as incorporating these interventions into clean birth kits or training programs for minimally skilled delivery assistants or family members. Efficacy trials for all chlorhexidine interventions are needed in low-resource settings in Africa, and the benefit of maternal vaginal cleansing beyond that provided by newborn skin cleansing needs to be determined.
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Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence
Pediatrics, 2005Co-Authors: Zulfiqar A Bhutta, Gary L. Darmstadt, Babar S Hasan, Rachel A HawsAbstract:Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based Neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning. Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and Neonatal Health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or Neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; Health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies. Results. A paucity of community-based data was found from developing-country studies on Health status impact for many interventions currently being considered for inclusion in Neonatal Health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in Neonatal Health care. Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn Health. The results of this study provide a foundation for policies and programs related to maternal and newborn Health and emphasizes the importance of Health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in Neonatal Health.
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Community-based interventions for improving perinatal and Neonatal Health outcomes in developing countries: a review of the evidence.
Pediatrics, 2005Co-Authors: Zulfiqar A Bhutta, Gary L. Darmstadt, Babar S Hasan, Rachel A HawsAbstract:Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of Neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on Neonatal Health and survival in developing-country communities has not been reported. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based Neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and Neonatal Health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or Neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; Health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies. A paucity of community-based data was found from developing-country studies on Health status impact for many interventions currently being considered for inclusion in Neonatal Health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in Neonatal Health care. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn Health. The results of this study provide a foundation for policies and programs related to maternal and newborn Health and emphasizes the importance of Health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in Neonatal Health.
Mirkuzie Woldie - One of the best experts on this subject based on the ideXlab platform.
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Technical efficiency of Neonatal Health services in primary Health care facilities of Southwest Ethiopia: a two-stage data envelopment analysis
Health Economics Review, 2019Co-Authors: Kiddus Yitbarek, Gelila Abraham, Gebeyehu Tsega, Melkamu Berhane, Sarah Hurlburt, Carlyn Mann, Am Adamu, Mirkuzie WoldieAbstract:BackgroundDisparity in resource allocation is an issue among various Health delivery units in Ethiopia. To sufficiently address this problem decision-makers require evidence on efficient allocation of resources. Therefore, the purpose of this study was to assess the technical efficiency of primary Health care units providing Neonatal Health services in Southwest Ethiopia.MethodsTwo-stage data envelopment analysis was conducted based on one-year (2016/17) data from 68 Health posts and 23 Health centers in Southwest Ethiopia. Primary data were collected from each of the facility, respective district Health offices and finance and economic cooperation offices. Technical efficiency scores were calculated using data envelopment analysis software version 2.1. Tobit regression was then applied to identify determinants of technical efficiency. STATA version 14 was used in the regression model and for descriptive statistics.ResultsBy utilizing the best combination of inputs, eight Health posts (11.76%) and eight Health centers (34.78%) were found to be technically efficient in delivering Neonatal Health services. Compared with others included in the analysis, inefficient Health delivery units were using more human and non-salary recurrent resources. The regression model indicated that there was a positive association between efficiency and the Health center head’s years of experience and the facility’s catchment population. Waiting time at the Health posts was found to negatively affect efficiency.ConclusionsMost of Health posts and the majority of Health centers were found to be technically inefficient in delivering Neonatal Health services. This indicates issues with the performance of these facilities with regards to the utilization of inputs to produce the current outputs. The existing resources could be used to serve additional neonates in the facilities.
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technical efficiency of Neonatal Health services in primary Health care facilities of southwest ethiopia a two stage data envelopment analysis
Health Economics Review, 2019Co-Authors: Kiddus Yitbarek, Gelila Abraham, Gebeyehu Tsega, Melkamu Berhane, Sarah Hurlburt, Carlyn Mann, Mirkuzie Woldie, Ayinengida AdamuAbstract:Disparity in resource allocation is an issue among various Health delivery units in Ethiopia. To sufficiently address this problem decision-makers require evidence on efficient allocation of resources. Therefore, the purpose of this study was to assess the technical efficiency of primary Health care units providing Neonatal Health services in Southwest Ethiopia. Two-stage data envelopment analysis was conducted based on one-year (2016/17) data from 68 Health posts and 23 Health centers in Southwest Ethiopia. Primary data were collected from each of the facility, respective district Health offices and finance and economic cooperation offices. Technical efficiency scores were calculated using data envelopment analysis software version 2.1. Tobit regression was then applied to identify determinants of technical efficiency. STATA version 14 was used in the regression model and for descriptive statistics. By utilizing the best combination of inputs, eight Health posts (11.76%) and eight Health centers (34.78%) were found to be technically efficient in delivering Neonatal Health services. Compared with others included in the analysis, inefficient Health delivery units were using more human and non-salary recurrent resources. The regression model indicated that there was a positive association between efficiency and the Health center head’s years of experience and the facility’s catchment population. Waiting time at the Health posts was found to negatively affect efficiency. Most of Health posts and the majority of Health centers were found to be technically inefficient in delivering Neonatal Health services. This indicates issues with the performance of these facilities with regards to the utilization of inputs to produce the current outputs. The existing resources could be used to serve additional neonates in the facilities.
Timothy Powell-jackson - One of the best experts on this subject based on the ideXlab platform.
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The effect of report cards on the coverage of maternal and Neonatal Health care: a factorial, cluster-randomised controlled trial in Uttar Pradesh, India.
The Lancet. Global health, 2019Co-Authors: Camilla Fabbri, Varun Dutt, Vasudha Shukla, Kultar Singh, Nehal Shah, Timothy Powell-jacksonAbstract:Report cards are a prominent strategy to increase the ability of citizens to express their view, improve public accountability, and foster community participation in the provision of Health services in low-income and middle-income countries. In India, social accountability interventions that incorporate report cards and community meetings have been implemented at scale, attracting considerable policy attention, but there is little evidence on their effectiveness in improving Health. We aimed to evaluate the effect of report cards, which contain information on village-level indicators of maternal and Neonatal Health care, and participatory meetings targeted at Health providers and community members (including local leaders) on the coverage of maternal and Neonatal Health care in Uttar Pradesh, India. We conducted a repeated cross-sectional, 2 × 2 factorial, cluster-randomised controlled trial, in which each cluster was a village (rural) or ward (urban). The clusters were randomly assigned to one of four groups: the provider group, in which we shared report cards and held participatory meetings with providers of maternal and Neonatal Health services; the community group, in which we shared report cards and held participatory meetings with community members (including local leaders); the providers and community group, in which report cards were targeted at both Health providers and the community; and the control group, in which report cards were not shared with anyone. We generated these report cards by collating data from household surveys and shared the report cards with the recipients (as determined by their assigned groups) in participatory meetings. The primary outcome was the proportion of women who had at least four antenatal care visits (ie, attended a clinic or were visited at home by a Health-care worker) during their last pregnancy. We measured outcomes with cross-sectional household surveys that were taken at baseline, at a first follow-up (after 8 months of the intervention), and at a second follow-up (21 months after the start of the intervention). Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN11070792. We surveyed eligible women for the baseline survey between Jan 13, and Feb 5, 2015. We then randomly assigned 44 clusters to the provider group, 45 clusters to the community group, 45 clusters to the provider and community group, and 44 clusters to the control group. Report cards of collated survey data were provided to recipient groups, as per their random allocation, in October, 2015, and in September, 2016. We ran the first follow-up survey between May 16 and June 10, 2016. We ran the second follow-up survey between June 18 and July 18, 2017. We measured the primary outcome in 3133 women (795 in the provider group, 781 in the community group, 798 in the provider and community group, and 759 in the control group) who gave birth during implementation of the intervention, between Feb 1, 2016, and July 18, 2017 (the end of the second follow-up survey). The report card intervention did not significantly affect the proportion of women who had at least four antenatal care visits (provider vs non-provider: odds ratio 0·85, 95% CI 0·65-1·13; community vs non-community: 0·86, 0·65-1·13). Maternal Health report cards containing information on village performance, targeted at either the community or Health providers, had no detectable effect on the coverage of maternal and Neonatal Health care. Future research should seek to understand how the content of information and the delivery of report cards affect the success of this type of social accountability intervention. Merck Sharp and Dohme. Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Marwân-al-qays Bousmah - One of the best experts on this subject based on the ideXlab platform.
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Regional Inequalities in Maternal and Neonatal Health Services in Iraq and Syria From 2000 to 2011
International Journal of Health Services, 2019Co-Authors: Sawsan Abdulrahim, Marwân-al-qays BousmahAbstract:We analyze regional inequalities in access to maternal and Neonatal Health services in Iraq and Syria during the period 2000–2011, before the rise of the Islamic State in Iraq and Syria, ISIS. Utilizing nationally representative survey data (Iraq 2000, 2006, 2011; Syria 2006, 2009), we examine changes in the rate of babies weighed at birth and women delivering at home. We calculate 4 regional inequality indicators: (1) extremal quotient, (2) interquartile quotient, (3) coefficient of variation, and (4) systematic component of variation. Despite national improvements in both countries over time, indicators show increasing regional inequalities in access to maternal and Neonatal Health services, particularly in Syria between 2006 and 2009. Spatial regression results indicate that these inequalities associate with inequalities in maternal education, rurality, and wealth. Regions where women experienced deteriorating access over time, reflecting overall inequalities, are those that fell under the control of ISIS. Inequalities in access to basic services (education and Health) deserve more attention in understanding social and political change in the Arab region.
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Regional Inequalities in Maternal and Neonatal Health Services in Iraq and Syria From 2000 to 2011.
International journal of health services : planning administration evaluation, 2019Co-Authors: Sawsan Abdulrahim, Marwân-al-qays BousmahAbstract:We analyze regional inequalities in access to maternal and Neonatal Health services in Iraq and Syria during the period 2000–2011, before the rise of the Islamic State in Iraq and Syria, ISIS. Util...
Zulfiqar A Bhutta - One of the best experts on this subject based on the ideXlab platform.
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State of Neonatal Health care in eight countries of the SAARC region, South Asia: how can we make a difference?
Paediatrics and international child health, 2015Co-Authors: Jai K Das, Arjumand Rizvi, Zaid Bhatti, Vinod K. Paul, Rajiv Bahl, Mohammod Shahidullah, Dharma S Manandhar, Hedayatullah Stanekzai, Sujeewa Amarasena, Zulfiqar A BhuttaAbstract:The South Asian Association for Regional Cooperation (SAARC) is an organization of eight countries--Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, Sri Lanka and Afghanistan. The major objectives of this review are to examine trends and progress in newborn and Neonatal Health care in the region. A landscape analysis of the current state of Neonatal mortality, stillbirths and trends over the years for each country and the effective interventions to reduce Neonatal mortality and stillbirths was undertaken. A modelling exercise using the Lives Saved Tool (LiST) was also undertaken to determine the impact of scaling up a set of essential interventions on Neonatal mortality and stillbirths. The findings demonstrate that there is an unacceptably high and uneven burden of Neonatal mortality and stillbirths in the region which together account for 39% of global Neonatal deaths and 41% of global stillbirths. Progress is uneven across countries in the region, with five of the eight SAARC countries having reduced their Neonatal mortality rate by more than 50% since 1990, while India (43%), Afghanistan (29%) and Pakistan (25%) have made slower progress and will not reach their MDG4 targets. The major causes of Neonatal mortality are intrapartum-related deaths, preterm birth complications and sepsis which account for nearly 80% of all deaths. The LiST analysis shows that a gradual increase in coverage of proven available interventions until 2020 followed by a uniform scale-up to 90% of all interventions until 2030 could avert 52% of Neonatal deaths (0.71 million), 29% of stillbirths (0.31 million) and achieve a 31% reduction in maternal deaths (0.25 million). The analysis demonstrates that the Maldives and Sri Lanka have done remarkably well while other countries need greater attention and specific focus on strategies to improve Neonatal Health.
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Impact of packaged interventions on Neonatal Health: a review of the evidence
Health policy and planning, 2007Co-Authors: Rachel A Haws, Abigail L Thomas, Zulfiqar A Bhutta, Gary L. DarmstadtAbstract:A disproportionate burden of infant and under-five childhood mortality occurs during the Neonatal period, usually within a few days of birth and against a backdrop of socio-economic deprivation in developing countries. To guide programmes aimed at averting these 4 million annual deaths, recent reviews have evaluated the efficacy and cost-effectiveness of individual interventions during the antenatal, intrapartum and postnatal periods in reducing Neonatal mortality, and packages of interventions have been proposed for wide-scale implementation. However, no systematic review of the empirical data on packages of interventions, including consideration of community-based intervention packages, has yet been performed. To address this gap, we reviewed peer-reviewed journals and grey literature to evaluate the content, impact, efficacy (implementation under ideal circumstances), effectiveness (implementation within Health systems), type of provider, and cost of packages of interventions reporting Neonatal Health outcomes. Studies employing more than one biologically plausible Neonatal Health intervention (i.e. package) and reporting Neonatal morbidity or mortality outcomes were included. Studies were ordered by study design and mortality stratum, and their component interventions classified by time period of delivery and service delivery mode. We found 41 studies that implemented packages of interventions and reported Neonatal Health outcomes, including 19 randomized controlled trials. True effectiveness trials conducted at scale in Health systems were completely lacking. No study targeted women prior to conception, antenatal interventions were largely micronutrient supplementation studies, and intrapartum interventions were limited principally to clean delivery. Few studies approximated complete packages recommended in The Lancet’s Neonatal Survival Series. Interventions appeared largely bundled out of convenience or funding requirements, rather than based on anticipated synergistic effects, like service delivery mode or cost-effectiveness. Only two studies reported cost-effectiveness data. The evidence base for the impact of Neonatal Health intervention packages is a weak foundation for guiding effective implementation of public Health programmes addressing Neonatal Health. Significant investment in effectiveness trials carefully tailored to local Health needs and conducted at scale in developing countries is required.
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Community-Based Interventions for Improving Perinatal and Neonatal Health Outcomes in Developing Countries: A Review of the Evidence
Pediatrics, 2005Co-Authors: Zulfiqar A Bhutta, Gary L. Darmstadt, Babar S Hasan, Rachel A HawsAbstract:Background. Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children Objective. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based Neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning. Methods. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and Neonatal Health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or Neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; Health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies. Results. A paucity of community-based data was found from developing-country studies on Health status impact for many interventions currently being considered for inclusion in Neonatal Health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in Neonatal Health care. Conclusions. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn Health. The results of this study provide a foundation for policies and programs related to maternal and newborn Health and emphasizes the importance of Health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in Neonatal Health.
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Community-based interventions for improving perinatal and Neonatal Health outcomes in developing countries: a review of the evidence.
Pediatrics, 2005Co-Authors: Zulfiqar A Bhutta, Gary L. Darmstadt, Babar S Hasan, Rachel A HawsAbstract:Infant and under-5 childhood mortality rates in developing countries have declined significantly in the past 2 to 3 decades. However, 2 critical indicators, maternal and newborn mortality, have hardly changed. World leaders at the United Nations Millennium Summit in September 2000 agreed on a critical goal to reduce deaths of children <5 years by two thirds, but this may be unattainable without halving newborn deaths, which now comprise 40% of all under-5 deaths. Greater emphasis on wide-scale implementation of proven, cost-effective measures is required to save women's and newborns' lives. Approximately 99% of Neonatal deaths take place in developing countries, mostly in homes and communities. A comprehensive review of the evidence base for impact of interventions on Neonatal Health and survival in developing-country communities has not been reported. This review of community-based antenatal, intrapartum, and postnatal intervention trials in developing countries aimed to identify (1) key behaviors and interventions for which the weight of evidence is sufficient to recommend their inclusion in community-based Neonatal care programs and (2) key gaps in knowledge and priority areas for future research and program learning. Available published and unpublished data on the impact of community-based strategies and interventions on perinatal and Neonatal Health status outcomes were reviewed. Evidence was summarized systematically and categorized into 4 levels of evidence based on study size, location, design, and reported impact, particularly on perinatal or Neonatal mortality. The evidence was placed in the context of biological plausibility of the intervention; evidence from relevant developed-country studies; Health care program experience in implementation; and recommendations from the World Health Organization and other leading agencies. A paucity of community-based data was found from developing-country studies on Health status impact for many interventions currently being considered for inclusion in Neonatal Health programs. However, review of the evidence and consideration of the broader context of knowledge, experience, and recommendations regarding these interventions enabled us to categorize them according to the strength of the evidence base and confidence regarding their inclusion now in programs. This article identifies a package of priority interventions to include in programs and formulates research priorities for advancing the state of the art in Neonatal Health care. This review emphasizes some new findings while recommending an integrated approach to safe motherhood and newborn Health. The results of this study provide a foundation for policies and programs related to maternal and newborn Health and emphasizes the importance of Health systems research and evaluation of interventions. The review offers compelling support for using research to identify the most effective measures to save newborn lives. It also may facilitate dialogue with policy makers about the importance of investing in Neonatal Health.
