Piloting an Approach for Identifying Very Small Newborns Born at Home and Incorporating Targeted Messages and Support

Session: Clinical Interventions for Newborn Health: Improving the Odds for Survival

Presenter: Chudamani Bhandari, Child Health Division, Department of Health Services, Ministry of Health and Population, Nepal
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Background:  The mortality associated with small babies is disproportionately high especially in low income countries, with more than 80% of neonatal deaths concentrated in Sub-Saharan Africa and South Asia. The fact that a significant proportion of these small babies could be saved with the application of simple, cost-effective behaviors has led to the development of an approach for community care of small babies.

Methodology:  Pregnant women are given a card measuring 6.9cm which, based on Nepal data, has optimal specificity and sensitivity for classifying babies above and below 2000gm birthweight. Women are instructed to use the card to check that their newborn’s foot at birth is longer than the card. If not, they are to call a toll-free number printed on the card, prompting a series of messages on provision of essential care for the small babies, including thermal regulation with skin-to-skin care, support for feeding practice including expression of breast milk and cup/spoon feeding if needed, and early recognition of danger signs and referral of the newborn. In the pilot districts, training has been provided to community health volunteers as the main vehicles for distributing cards. At the time of distribution, they also instruct the woman to call the CHW to the home if they have a very small newborn. The CHWs, in turn, provide reinforcement counseling and support during home visits.

Results: It’s expected that there will be improvements in behavioral practices associated with small babies in the community. It’s also expected that targeting of postnatal visits will reduce the burden placed on the health systems, ensuring that the most vulnerable populations are being reached with better outcomes.

Conclusion: This presentation will report on early findings of a 2-district pilot of this new approach. We will present on the intervention and on documented changes in practices and care-seeking.