Thursday, 21 February 2008

Will better medicare bring down infant mortality rate? Naandi Foundation experts to find out

Syed Akbar
Hyderabad, Sept 21: City health researchers have now embarked on an interesting mission to find out whether provision of better medicare will bring down the high infant mortality rate in Andhra Pradesh.
Andhra Pradesh has one of the highest infant mortality rates in the country with 57 children out of every 1000 live births dying in infancy.
The group has taken up trials in the backward Mahbubnagar district for evaluation of the neonatal deaths prevention programme. The idea is to find out whether neonatal mortality could be brought down through systemic changes to the provision and promotion of healthcare.
The study is being conducted by Hyderabad-based Global Partnerships of Naandi Foundation in association with Effective Intervention Centre for Economic Performances, London School of Economics and Medical Statistics Unit, London School of Hygiene and Tropical Medicine.
There is evidence that relatively inexpensive interventions may be able to prevent up to 75 per cent of these deaths. Among districts in the State, Mahbubnagar has very high neonatal mortality rates. It is estimated that
the mortality rate in this backward district is as high as nine per cent or 90 deaths for every 1000 live child births. One out of 22 infants in India does not reach the second month of life.
"However, there's very little reliable information quantifying neonatal survival rates in rural areas and tribal regions, although these rates are known anecdotally to be even higher," the study points out. The district suffers from a vicious cycle of both poor supply of and small demand for health care services. The trial will assess whether a package of interventions to facilitate systemic changes to the provision and promotion of healthcare may be able to substantially reduce neonatal mortality in this district and be cost-effective. If successful, the trial is designed so that it should be possible to substantially scale up the project in regions with similarly high neonatal mortality throughout Andhra Pradesh and elsewhere in the country.
The trial study will be a cluster-randomised controlled trial involving 464 villages in Mahbubnagar. The package of interventions will first be introduced in half of the villages with the others serving as controls.
The trial will run for a period of three years. The intervention in the trial has two key elements: a community health promotion campaign and a system to contract out healthcare to non-public institutions.
The health promotion campaign will include a health education campaign, participatory discussion groups, training of village health workers and midwives, and improved coordination of antenatal services. The
intervention group will also have subsidised access to pregnancy-related healthcare services at non-public health centres. The primary outcome of the trial will be neonatal mortality. Secondary outcomes will include age at and cause of neonatal death, neonatal morbidity, maternal mortality and morbidity, health service usage, costs and several process and knowledge outcomes.
The study  will be run by independent research and service delivery arms and supervised by a trial steering committee. A data monitoring committee will be put in place to monitor the trial and recommend
stopping/continuation according to well-established medical rules.

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