Home visits by community health workers to prevent neonatal deaths in developing countries: a systematic review.
OBJECTIVE
To determine whether home visits for neonatal care by community health workers can reduce infant and neonatal deaths and stillbirths in resource-limited settings.


METHODS
We conducted a systematic review up to 2008 of controlled trials comparing various intervention packages, one of them being home visits for neonatal care by community health workers. We performed meta-analysis to calculate the pooled risk of outcomes.


RESULTS
Five trials, all from south Asia, satisfied the inclusion criteria. The intervention packages included in them comprised antenatal home visits (all trials), home visits during the neonatal period (all trials), home-based treatment for illness (3 trials) and community mobilization efforts (4 trials). Meta-analysis showed a reduced risk of neonatal death (relative risk, RR: 0.62; 95% confidence interval, CI: 0.44-0.87) and stillbirth (RR: 0.76; 95% CI: 0.65-0.89), and a significant improvement in antenatal and neonatal practice indicators (> 1 antenatal check-up, 2 doses of maternal tetanus toxoid, clean umbilical cord care, early breastfeeding and delayed bathing). Only one trial recorded infant deaths (RR: 0.41; 0.30-0.57). Subgroup analyses suggested a greater survival benefit when home visit coverage was ≥ 50% (P < 0.001) and when both preventive and curative interventions (injectable antibiotics) were conducted (P = 0.088).


CONCLUSIONS
Home visits for antenatal and neonatal care, together with community mobilization activities, are associated with reduced neonatal mortality and stillbirths in southern Asian settings with high neonatal mortality and poor access to facility-based health care.
Gogia
Siddhartha
S
Sitaram Bhartia Institute of Science and Research, New Delhi, India.
Sachdev
Harshpal Singh
HS
D003150:Community Health Workers / Q000458:organization & administration / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000458:organization & administration / Q000706:statistics & numerical data; D006699:Home Care Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D011295:Prenatal Care / Q000458:organization & administration / Q000706:statistics & numerical data; D050497:Stillbirth / Q000453:epidemiology