While women, newborn and under-five child death rates in developing countries have declined significantly in the past two to three decades, newborn mortalities have hardly changed. It is now been recognised that almost half of newborn deaths can be prevented by tetanus toxoid immunisation of the mothers; clean and skilled care at the birth; newborn resuscitation; exclusive breastfeeding; clean umbilical cord care; and management of infections in the newborns. In developing countries, almost two-thirds of births occur at home and only half are attended by a trained birth attendant. It has also been known that a large proportion of these deaths and diseases can be potentially addressed by developing community-based packaged interventions that should be integrated with local health systems.
The review authors found 18 randomised and quasi-randomised controlled studies evaluating the impact of community-based intervention packages for the prevention of maternal illness and death in improving newborn health outcomes. These studies were mostly conducted in developing countries (India, Bangladesh, Pakistan, Gambia, Nepal, Indonesia) with one additional study in Greece. Women in areas assigned to receive a community-based intervention package with health workers receiving additional training had decreased illnesses and complications during pregnancy and birth associated with decreased stillbirths, perinatal and neonatal deaths. Referrals rates to health facilities for pregnancy related complications, and initiation of breastfeeding within an hour of birth were also improved. This review offers encouraging evidence of the value of integrating maternal and newborn care in community settings through a range of strategies, many of which can be packaged effectively for delivery through a range of community health workers.