title: Cost-effectiveness of essential newborn care training in urban first-level facilities.
abstract: OBJECTIVE
  To determine the cost-effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) training of health care providers in first-level facilities in the 2 largest cities in Zambia.
  
  
  METHODS
  Data were extracted from a study in which the effectiveness of the ENC training was evaluated (including universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, skin-to-skin care, care of the small infant, danger signs, and common illnesses). The costs to train an ENC instructor for each first-level delivery facility and the costs of salary/benefits for 2 coordinators responsible for maintenance of the program were recorded in 2005 US dollars. The incremental costs per life gained and per disability-adjusted life-year averted were calculated.
  
  
  METHODS
  A 5-day ENC training-of-trainers was conducted in Lusaka, Zambia, to certify 18 college-trained midwives as ENC instructors. The instructors trained all clinic midwives working in their first-level facilities as part of a before-and-after study of the effect of ENC training on early neonatal mortality conducted from Oct 2004 to Nov 2006.
  
  
  RESULTS
  All-cause 7-day (early) neonatal mortality decreased from 11.5 per 1000 to 6.8 per 1000 live births after ENC training of the clinic midwives (relative risk: 0.59; 95% confidence interval: 0.48-0.77; P < .001; 40 615 births). The intervention costs were $208 per life saved and $5.24 per disability-adjusted life-year averted.
  
  
  CONCLUSIONS
  ENC training of clinic midwives who provide care in low-risk facilities is a low-cost intervention that can reduce early neonatal mortality in these settings.
authors.affiliation: University of Alabama at Birmingham, 9380 Women and Infants Center, 1700 6th Avenue South, Birmingham, AL 35233, USA.
authors.forename: Albert
authors.initials: A
authors.lastname: Manasyan
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: Sara
authors.initials: S
authors.lastname: Krzywanski
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D005260:Female; D017048:Health Care Costs; D006282:Health Personnel / Q000191:economics* / Q000193:education; D006801:Humans; D007224:Infant Care / Q000191:economics* / Q000592:standards; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D008297:Male; D009721:Nurse Midwives / Q000191:economics / Q000193:education*; D010371:Pediatric Nursing / Q000193:education; D015397:Program Evaluation; D018570:Risk Assessment; D014944:World Health Organization; D015024:Zambia