title: Effect of training traditional birth attendants on neonatal mortality (Lufwanyama Neonatal Survival Project): randomised controlled study.
abstract: OBJECTIVE
  To determine whether training traditional birth attendants to manage several common perinatal conditions could reduce neonatal mortality in the setting of a resource poor country with limited access to healthcare.
  
  
  METHODS
  Prospective, cluster randomised and controlled effectiveness study.
  
  
  METHODS
  Lufwanyama, an agrarian, poorly developed district located in the Copperbelt province, Zambia. All births carried out by study birth attendants occurred at mothers' homes, in rural village settings.
  
  
  METHODS
  127 traditional birth attendants and mothers and their newborns (3559 infants delivered regardless of vital status) from Lufwanyama district.
  
  
  METHODS
  Using an unblinded design, birth attendants were cluster randomised to intervention or control groups. The intervention had two components: training in a modified version of the neonatal resuscitation protocol, and single dose amoxicillin coupled with facilitated referral of infants to a health centre. Control birth attendants continued their existing standard of care (basic obstetric skills and use of clean delivery kits).
  
  
  METHODS
  The primary outcome was the proportion of liveborn infants who died by day 28 after birth, with rate ratios statistically adjusted for clustering. Secondary outcomes were mortality at different time points; and comparison of causes of death based on verbal autopsy data.
  
  
  RESULTS
  Among 3497 deliveries with reliable information, mortality at day 28 after birth was 45% lower among liveborn infants delivered by intervention birth attendants than control birth attendants (rate ratio 0.55, 95% confidence interval 0.33 to 0.90). The greatest reductions in mortality were in the first 24 hours after birth: 7.8 deaths per 1000 live births for infants delivered by intervention birth attendants compared with 19.9 per 1000 for infants delivered by control birth attendants (0.40, 0.19 to 0.83). Deaths due to birth asphyxia were reduced by 63% among infants delivered by intervention birth attendants (0.37, 0.17 to 0.81) and by 81% within the first two days after birth (0.19, 0.07 to 0.52). Stillbirths and deaths from serious infection occurred at similar rates in both groups.
  
  
  CONCLUSIONS
  Training traditional birth attendants to manage common perinatal conditions significantly reduced neonatal mortality in a rural African setting. This approach has high potential to be applied to similar settings with dispersed rural populations. Trial registration Clinicaltrials.gov NCT00518856.
authors.affiliation: Center for Global Health and Development, Boston University, Boston, MA, USA. cgill@bu.edu
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gill
authors.forename: Grace
authors.initials: G
authors.lastname: Phiri-Mazala
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Guerina
authors.forename: Joshua
authors.initials: J
authors.lastname: Kasimba
authors.forename: Charity
authors.initials: C
authors.lastname: Mulenga
authors.forename: William B
authors.initials: WB
authors.lastname: MacLeod
authors.forename: Nelson
authors.initials: N
authors.lastname: Waitolo
authors.forename: Anna B
authors.initials: AB
authors.lastname: Knapp
authors.forename: Mark
authors.initials: M
authors.lastname: Mirochnick
authors.forename: Arthur
authors.initials: A
authors.lastname: Mazimba
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Fox
authors.forename: Lora
authors.initials: L
authors.lastname: Sabin
authors.forename: Philip
authors.initials: P
authors.lastname: Seidenberg
authors.forename: Jonathon L
authors.initials: JL
authors.lastname: Simon
authors.forename: Davidson H
authors.initials: DH
authors.lastname: Hamer
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002983:Clinical Competence / Q000592:standards*; D016000:Cluster Analysis; D036861:Delivery, Obstetric / Q000193:education* / Q000295:instrumentation; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality*; D008875:Middle Aged; D008880:Midwifery / Q000193:education* / Q000592:standards; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D011446:Prospective Studies; D012017:Referral and Consultation; D012151:Resuscitation; D012423:Rural Health; D015024:Zambia / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents