Effect of timing of first postnatal care home visit on neonatal mortality in Bangladesh: a observational cohort study.
OBJECTIVE
To assess the effect of the timing of first postnatal home visit by community health workers on neonatal mortality.


METHODS
Analysis of prospectively collected data using time varying discrete hazard models to estimate hazard ratios for neonatal mortality according to day of first postnatal home visit.


METHODS
Data from a community based trial of neonatal care interventions conducted in Bangladesh during 2004-5.


METHODS
Neonatal mortality.


RESULTS
9211 live births were included. Among infants who survived the first day of life, neonatal mortality was 67% lower in those who received a visit on day one than in those who received no visit (adjusted hazard ratio 0.33, 95% confidence interval 0.23 to 0.46; P<0.001). For those infants who survived the first two days of life, receiving the first visit on the second day was associated with a 64% lower neonatal mortality than in those who did not receive a visit (adjusted hazard ratio 0.36, 0.23 to 0.55; P<0.001). First visits on any day after the second day of life were not associated with reduced mortality.


CONCLUSIONS
In developing countries, especially where home delivery with unskilled attendants is common, postnatal home visits within the first two days of life by trained community health workers can significantly reduce neonatal mortality.
Baqui
Abdullah H
AH
Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. abaqui@jhsph.edu
Ahmed
Saifuddin
S
El Arifeen
Shams
S
Darmstadt
Gary L
GL
Rosecrans
Amanda M
AM
Mannan
Ishtiaq
I
Rahman
Syed M
SM
Begum
Nazma
N
Mahmud
Arif B A
AB
Seraji
Habibur R
HR
Williams
Emma K
EK
Winch
Peter J
PJ
Santosham
Mathuram
M
Black
Robert E
RE
D001459:Bangladesh; D015331:Cohort Studies; D003152:Community Health Nursing / Q000458:organization & administration*; D004522:Educational Status; D005260:Female; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D010298:Parity; D018743:Perinatal Care / Q000458:organization & administration*; D054238:Perinatal Mortality; D011181:Postnatal Care / Q000458:organization & administration*; D011247:Pregnancy; D016016:Proportional Hazards Models; D012923:Social Class; D013997:Time Factors
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