Skip to main content

Main menu

  • Home
  • Issues
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • COVID-19 Articles
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
  • About
    • About GHSP
    • Editorial Team
    • Editorial Board
    • FAQs
    • Instructions for Reviewers
  • Sign up for Alerts
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • News
    • GHSP Call for Papers
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search

User menu

  • My Alerts

Search

  • Advanced search
Global Health: Science and Practice
  • Other Useful Sites
    • GH eLearning
    • GHJournal Search
  • My Alerts

Global Health: Science and Practice

Dedicated to what works in global health programs

Advanced Search

  • Home
  • Issues
    • Current Issue
    • Advance Access
    • Archive
    • Supplements
    • COVID-19 Articles
    • Topic Collections
  • For Authors
    • Instructions for Authors
    • Submit Manuscript
  • About
    • About GHSP
    • Editorial Team
    • Editorial Board
    • FAQs
    • Instructions for Reviewers
  • Sign up for Alerts
  • Webinars
    • Local Voices Webinar
    • Connecting Creators and Users of Knowledge
    • Publishing About Programs in GHSP
  • News
    • GHSP Call for Papers
  • Visit GHSP on Facebook
  • Follow GHSP on Twitter
  • RSS
  • Find GHSP on LinkedIn
ORIGINAL ARTICLE
Open Access

Effect on Neonatal Mortality of Newborn Infection Management at Health Posts When Referral Is Not Possible: A Cluster-Randomized Trial in Rural Ethiopia

Tedbabe Degefie Hailegebriel, Brian Mulligan, Simon Cousens, Bereket Mathewos, Steve Wall, Abeba Bekele, Jeanne Russell, Deborah Sitrin, Biruk Tensou, Joy Lawn, Joseph de Graft Johnson, Hailemariam Legesse, Sirak Hailu, Assaye Nigussie, Bogale Worku and Abdullah Baqui
Global Health: Science and Practice June 2017, 5(2):202-216; https://doi.org/10.9745/GHSP-D-16-00312
Tedbabe Degefie Hailegebriel
aUnited Nations Children's Fund (UNICEF), New York, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: tdegefie@yahoo.com
Brian Mulligan
bJohn Snow Research and Training Institute, Inc., Yangon, Myanmar.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Simon Cousens
cLondon School of Hygiene and Tropical Medicine, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Bereket Mathewos
dSave the Children International, Addis Ababa, Ethiopia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Steve Wall
eSave the Children, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Abeba Bekele
dSave the Children International, Addis Ababa, Ethiopia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jeanne Russell
eSave the Children, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Deborah Sitrin
eSave the Children, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Biruk Tensou
dSave the Children International, Addis Ababa, Ethiopia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Joy Lawn
cLondon School of Hygiene and Tropical Medicine, London, UK.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Joseph de Graft Johnson
eSave the Children, Washington, DC, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hailemariam Legesse
fUNICEF, Addis Ababa, Ethiopia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sirak Hailu
gWorld Health Organization, Windhoek, Namibia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Assaye Nigussie
hBill & Melinda Gates Foundation, Seattle, WA, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Bogale Worku
iEthiopian Pediatrics Society, Addis Ababa, Ethiopia.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Abdullah Baqui
jInternational Center for Maternal and Newborn Health, John Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
PreviousNext
  • Article
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF
Loading

Figures & Tables

Figures

  • Tables
  • FIGURE 1
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 1

    Relationship Between Health Extension Workers, Volunteers, and Households in Identifying and Managing Newborn Infections, Rural Ethiopia

    Abbreviations: HEW, Health Extension Worker; IMNCI, integrated management of neonatal and childhood illnesses; PSBI, possible severe bacterial infection; V, Volunteer.

  • FIGURE 2
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 2

    Algorithm for Assessment, Classification, and Treatment of Newborn Infection by Health Extension Workers at Intervention Health Posts

    Abbreviation: PSBI, possible severe bacterial infection.

  • FIGURE 3
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 3

    Number of Newborns With at Least 1 Sign of PSBI Presenting at Health Centers or Health Posts by Study Arm, Rural Ethiopia, July 2011–June 2013

    Abbreviation: PSBI, possible severe bacterial infection.

  • FIGURE 4
    • Download figure
    • Open in new tab
    • Download powerpoint
    FIGURE 4

    Study Allocation and Participants Interviewed and Included in Main Outcome Analysis Using Endline Survey

    Abbreviation: HH, household.

Tables

  • Figures
    • View popup
    TABLE 1. Description of Newborn Infection Management Intervention by Arm and Health System Level, Rural Ethiopia, 2008–2013
    ControlIntervention
    Community and Household
    Half-day meetings to orient religious and administrative leaders and other community representatives on the study purpose and to obtain community consent to conduct study in these areasYesYes
    1-day meetings with religious and administrative leaders and other community representatives to select female volunteers for the studyYesYes
    4-day training for HEWs and volunteers on conducting home visits to counsel women and families on the importance of antenatal care, facility delivery, and postnatal care; birth preparedness (saving money, planning place of delivery, transport, and blood donor); healthy newborn care practices; recognition of danger signs in mothers and newborns that require prompt care seeking; postpartum family planning; and identification and referral of sick newbornsYesYes
    2-day refresher training for volunteers to reinforce initial 4-day trainingYesYes
    3-day training for HEWs on how to work with and support volunteersYesYes
    Identification of pregnant women by study volunteersYesYes
    Pregnancy and postnatal home visits by HEWs and volunteers per trainingYesYes
    1-day meetings to raise community awareness of the availability of treatment for sick newborns at health postsNoYes
    Health Post
    6-day training for HEWs on assessment and referral of newborns with signs of PSBI and case management for sick children older than 2 months (using national iCCM materials)YesYes
    1-day training for HEWs on treatment of newborns with signs of PSBI when referral is not possible or acceptableNoYes
    Monthly meetings among PO, HEWs, and volunteers to reinforce counseling skills, referral of sick newborns, and reporting on home visitsYesYes
    Supervision of HEWs by POsYesYes
    Provision of antibiotics and supplies for PSBI case management to health postsNoYes
    Treatment of newborns with signs of PSBI by HEWs, if referral to the health center was not possible or acceptableNoYes
    Monthly PSBI case management review meetings between POs and HEWsNoYes
    Documentation of symptoms, diagnosis, treatment initiation, and referrals for sick young infants by HEWs on iCCM registersYesYes
    Tracking of the number and timing of antibiotic doses and outcome by HEWsNoYes
    Health Center
    7-day training for health center staff on IMNCI using national curriculumYesYes
    Provision of antibiotics and supplies for PSBI case management to health centersYesYes
    Documentation of symptoms, diagnosis, treatment initiation, and referrals for sick young infants by health center staff on IMNCI registersYesYes
    • Abbreviations: HEW, health extension worker; iCCM, integrated community case management; IMNCI, integrated management of neonatal and childhood illnesses; PSBI, possible severe bacterial infection; PO, project officer.

    • View popup
    TABLE 2. Basic Sociodemographic Characteristics at Baseline (2008–2009), Rural Ethiopia
    ComparisonIntervention
    No. of households interviewed58,94460,408
    No. of residents per household, median55
    No. of women of reproductive age interviewed58,49756,733
    General fertility rate (no. of live births per 1,000 women of reproductive age)163169
    No. of women with a live birth in past 1 year9,5319,600
    Age in years of women with live birth in past 1 year, mean (SD) (range)28 (6) (14–50)28 (6) (14–50)
    No. of lifetime live births prior to interview among women with live birth in past 1 year, median44
    Neonatal mortality rate among women with live birth in past 1 year (deaths during days 0–27 per 1,000 live births)33.635.0
    No. of women with a live birth in past 60 days1,3711,358
    Percentage of women with live birth in past 60 days who ever attended school33%26%
    No. of years of education among women with live birth in past 60 days who ever attended school44
    Wealth quintiles among women with live birth in past 60 days, No. (%)
        Lowest287 (21%)253 (19%)
        2nd258 (19%)280 (21%)
        3rd274 (20%)273 (20%)
        4th261 (19%)280 (21%)
        Highest280 (20%)262 (19%)
        Missing11 (1%)10 (1%)
    • Abbreviation: SD, standard deviation.

    • View popup
    TABLE 3. Comparison of Assessments of Newborn Danger Signs by HEWs and POs, Rural Ethiopia, 2011–2012
    Danger SignsIdentified by Both the HEW and POIdentified by HEW OnlyIdentified by PO OnlyAgree Sign Not Present
    Convulsions200825
    Not feeding well410811
    Chest in-drawing1440840
    Grunting851832
    Lack of movement4220810
    Fever1002797
    Low temperature1312769
    • Abbreviations: HEW, Health Extension Worker; PO, Project Officer.

    • View popup
    TABLE 4. Neonatal Deaths at Baseline (2008–2009) and Endline (2013) by Study Arm and Timing of Deaths, Rural Ethiopia
    Timing of Neonatal DeathsComparisonInterventionIntervention vs. Comparison
    Denominator NMortality Rate (n)Denominator NMortality Rate (n)Adjusted Risk Ratioa (95% CI)P Value
    Days 0–27
        Baseline9,531 live births33.6 (320)9,600 live births35.0 (336)0.94 (0.72, 1.22).61
        Endline9,003 live births22.7 (204)9,744 live births24.2 (236)
    Days 0–1
        Baseline9,531 live births19.4 (185)9,600 live births17.4 (167)1.04 (0.70, 1.55).83
        Endline9,003 live births11.6 (104)9,744 live births15.0 (146)
    Days 2–27
        Baseline9,346 surviving day 114.4 (135)9,433 surviving day 117.9 (169)0.83 (0.55, 1.24).33
        Endline8,899 surviving day 111.2 (100)9,598 surviving day 19.4 (90)
    • Abbreviation: CI, confidence interval.

    • ↵a Endline intervention vs. comparison, adjusted for baseline mortality risk and region.

PreviousNext
Back to top

In this issue

Global Health: Science and Practice: 5 (2)
Global Health: Science and Practice
Vol. 5, No. 2
June 27, 2017
  • Table of Contents
  • About the Cover
  • Index by Author
  • Complete Issue (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about Global Health: Science and Practice.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Effect on Neonatal Mortality of Newborn Infection Management at Health Posts When Referral Is Not Possible: A Cluster-Randomized Trial in Rural Ethiopia
(Your Name) has forwarded a page to you from Global Health: Science and Practice
(Your Name) thought you would like to see this page from the Global Health: Science and Practice web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Effect on Neonatal Mortality of Newborn Infection Management at Health Posts When Referral Is Not Possible: A Cluster-Randomized Trial in Rural Ethiopia
Tedbabe Degefie Hailegebriel, Brian Mulligan, Simon Cousens, Bereket Mathewos, Steve Wall, Abeba Bekele, Jeanne Russell, Deborah Sitrin, Biruk Tensou, Joy Lawn, Joseph de Graft Johnson, Hailemariam Legesse, Sirak Hailu, Assaye Nigussie, Bogale Worku, Abdullah Baqui
Global Health: Science and Practice Jun 2017, 5 (2) 202-216; DOI: 10.9745/GHSP-D-16-00312

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Effect on Neonatal Mortality of Newborn Infection Management at Health Posts When Referral Is Not Possible: A Cluster-Randomized Trial in Rural Ethiopia
Tedbabe Degefie Hailegebriel, Brian Mulligan, Simon Cousens, Bereket Mathewos, Steve Wall, Abeba Bekele, Jeanne Russell, Deborah Sitrin, Biruk Tensou, Joy Lawn, Joseph de Graft Johnson, Hailemariam Legesse, Sirak Hailu, Assaye Nigussie, Bogale Worku, Abdullah Baqui
Global Health: Science and Practice Jun 2017, 5 (2) 202-216; DOI: 10.9745/GHSP-D-16-00312
del.icio.us logo Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Statistics from Altmetric.com

Jump to section

  • Article
    • Abstract
    • INTRODUCTION
    • METHODS
    • RESULTS
    • DISCUSSION
    • CONCLUSIONS
    • Acknowledgments
    • Notes
    • REFERENCES
  • Figures & Tables
  • Info & Metrics
  • Comments
  • PDF

Related Articles

  • Reducing Sepsis Deaths in Newborns Through Home Visitation and Active Case Detection: Is it Realistic?
  • PubMed
  • Google Scholar

Cited By...

  • Community-based newborn care utilisation and associated factors in Geze Gofa rural district, South Ethiopia: a community-based cross-sectional study
  • Characterising innovations in maternal and newborn health based on a common theory of change: lessons from developing and applying a characterisation framework in Nigeria, Ethiopia and India
  • Google Scholar

More in this TOC Section

  • Lessons Learned From the Use of the Most Significant Change Technique for Adaptive Management of Complex Health Interventions
  • A New Contraceptive Diaphragm in Niamey, Niger: A Mixed Methods Study on Acceptability, Use, and Programmatic Considerations
  • What Distinguishes Women Who Choose to Self-Inject? A Prospective Cohort Study of Subcutaneous Depot Medroxyprogesterone Acetate Users in Ghana
Show more ORIGINAL ARTICLE

Similar Articles

Subjects

  • Health Topics
    • Maternal, Newborn, and Child Health
US AIDJohns Hopkins Center for Communication ProgramsUniversity of Alberta

Follow Us On

  • Twitter
  • Facebook
  • LinkedIn
  • RSS

Articles

  • Current Issue
  • Advance Access Articles
  • Past Issues
  • Topic Collections
  • Most Read Articles
  • Supplements

More Information

  • Submit a Paper
  • Instructions for Authors
  • Instructions for Reviewers
  • GH Journals Database

About

  • About GHSP
  • Editorial Board
  • FAQs
  • Contact Us
  • Privacy Policy

© 2022 Creative Commons Attribution 4.0 International License. ISSN: 2169-575X

Powered by HighWire