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Table 6 Observational, quasi-experimental, and cluster randomized trials of community-based neonatal resuscitation

From: Neonatal resuscitation and immediate newborn assessment and stimulation for the prevention of neonatal deaths: a systematic review, meta-analysis and Delphi estimation of mortality effect

Author Country Study design Intervention definition Simultaneous Interventions Intervention Coverage Outcomes: Definition Preterm vs. Intrapartum Death N (Births)
A = control
B = comparison
Effect Size
RR/OR
(95% CI)
Pratinidhi et al, 1985[50] Pune, India Before-and-after CHW training in basic resuscitation with mouth to mouth Management of low birth weight, preterm, feeding, illness, cord cutting, feeding, nutrition; 80% of home births received CHW care; 75% of births at home 1) NMR;
2) PMR
Not stated A) 1444;
B) 1546
1) RR 0.75
2) RR 0.98
Daga SR et al, 1991[51] Maharashtra, India Before-and-after, no control TBA training in basic resuscitation with mouth-to-mouth breathing Management of low birth weight, hypothermia; transport and referral of high risk babies to hospital TBAs attended 90% of deliveries 1) NMR;
2) PMR;
3) SBR
Not stated A) 321;
B) 660
1) RR 0.59 (0.32-1.09);
2) RR 0.39 (0.21-0.69);
3) RR 0.49 (0.16, 1.50)
Kumar R et a; 1998[55] Haryana, India Quasi-experimental Advanced TBA training modern resuscitation with bag mask ventilation and mucus extractor NS TBAs delivered 92% of babies at home; 1) Asphyxia mortality (Verbal Autopsy);
2) PMR
Combined "not breathing" A) 964;
B) 884
1) RR 0.30 (0.11-0.81)
2) RR 0.82 (0.56-1.19)
Bang AT et al 2005[5, 72] Gadichiroli, India Quasi-experimental 1) 1996-1999: CHW+TBA attend deliveries together, basic resuscitation with tube-mask; 2) 1999-2003: Bag mask. Refresher training every 2 months. Community treatment of suspected neonatal sepsis, essential newborn care VHWs attended 84% of deliveries 1) Asphyxia mortality (Verbal autopsy)
2) NMR
3) PMR
4) SBR
5) ENMR
Combined "not breathing" [Failure to breathe at 1, 5 min] Before-after comparison
A) 763 (95-6);
B) 5510 (96-03)
QE comparison
A)1108
B) 979
1) RR 0.35 (0.15-0.78)a
2) RR 0.41 (0.26-0.66)b
3) RR 0.50 (0.35-0.71)b
4) RR 0.58 (0.36-0.93)b
5) RR 0.44 (0.27-0.73)b
Ariawan I, et al 2006[54] Cirebon, Indonesia Before-and-after, no control Community mid-wife training in resuscitation with tube-mask, refresher training 3, 6, 9 month and VCD refresher video; training in "post-resuscitation" care Not stated 60% of asphyxia cases managed by midwives; uncertain coverage rate 1) Asphyxia mortality (Verbal autopsy);
2) NMR;
3) SBR
Not stated A) est 44,000;
B) est 44,000
1) RR 0.39 (0.31-0.48)
2) RR 0.60 (0.53-0.68)
3) RR 0.39 (0.31-0.48)
Carlo W et al 2010[52] Argentina, DR Congo, Guatemala, India, Pakistan, Zambia Before-and-after ENC; cluster RCT for NRP training Training of community birth attendants (TBAs, nurses, midwives, and physicians) in WHO Essential Newborn Care, including basic resuscitation with bag-mask ventilation Clean delivery, thermal protection, breastfeeding, kangaroo care 78% of births attended by community birth attendant after ENC training 1) PMR
2) SBR
3) ENMR
BW < 1500 g excluded A) 22,626;
B) 35,017
1) RR 0.85 (0.70-1.02)
2) RR 0.69 (0.54-0.88)
3) RR 0.99 (0.81-1.22)
Gill C et al 2011[53] Zambia Cluster RCT TBA Training in modified neonatal resuscitation program (NRP) w/facemask; competence assessments with refresher trainings every 3-4 mos. Thermal care, Facilitated referral for presumptive neonatal sepsis (amoxicillin and referral) Undetermined 1) NMR
2) Day 1 mortality
3) Asphyxia NMR (Verbal autopsy)
4)PMR
Single cause assigned by VA "asphyxia" or "preterm" A) 1920
B) 1517
1) aRR 0.55, (0.33-0.90)
2) aRR 0.40, (0.19-.83)
3) aRR 0.37 (0.17-0.81)
4) aRR 0.72 (0.51-1.00)
Azad K et al 2011 [73] Bangladesh Cluster RCT, factorial design Intervention arm: TBATraining neonatal resuscitation with bag-valve mask, with subsequent retraining; Control: TBA Training in mouth-to-mouth resuscitation Intervention and control: Clean delivery, danger signs, emergency preparedness, facility referral. Women's participatory groups in half of clusters Intervention Coverage: 22% of home deliveries attended by trained TBA; Control 19% by trained TBA 1) ENMR Not stated A) 13195
B) 12519
1) 0.95 (0.75-1.21)
  1. a Before-after comparison period 1995-6 versus 1996-2003
  2. b Calculated from data presented in paper for year 3 of intervention (1997-1998) comparing experimental vs. control areas[72]