title: ENC training reduces perinatal mortality in Karnataka, India.
abstract: OBJECTIVE
  To evaluate the effect of World Health Organization Essential Newborn Care course and the American Academy of Pediatrics Neonatal Resuscitation Program training on perinatal mortality in rural India.
  
  
  METHODS
  This study was part of a multi-country prospective, community-based cluster randomized controlled trial. Birth, 7-day and 28-day neonatal outcomes for all women with pregnancies greater than 28 weeks in the 26 study communities in Karnataka, India were included. Mortality rates pre- and post-Essential Newborn Care training were collected prospectively and then communities randomized to either receive neonatal resuscitation or refresher newborn care training in the control clusters.
  
  
  RESULTS
  Consent was obtained on 99% of the 25,096 births. Perinatal mortality for infants ≥500 g decreased from 52 to 36/1000 after newborn care training (RR 0.7; 95% CI 0.5, 0.9); stillbirth decreased from 23 to 14/1000 (RR 0.62; 95% CI 0.46, 0.83) and early neonatal mortality decreased from 29 to 22/1000 (RR 0.74; 95% CI 0.53, 1.03). Mortality was not reduced further with resuscitation training.
  
  
  CONCLUSIONS
  Using a pre-post design, World Health Organization Essential Newborn Care community birth attendant training resulted in a significant reduction in perinatal mortality. In low-resource settings, the newborn care training package appears to be an effective intervention to decrease perinatal mortality.
authors.affiliation: Jawaharlal Nehru Medical College, Belgaum, India. sgoudar@jnmc.edu
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.forename: Sangappa M
authors.initials: SM
authors.lastname: Dhaded
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.forename: Vishwanath D
authors.initials: VD
authors.lastname: Patil
authors.forename: Niranjana S
authors.initials: NS
authors.lastname: Mahantshetti
authors.forename: Roopa M
authors.initials: RM
authors.lastname: Bellad
authors.forename: Bhala
authors.initials: B
authors.lastname: Kodkany
authors.forename: Janet
authors.initials: J
authors.lastname: Moore
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
mesh_terms: D000465:Algorithms; D015536:Down-Regulation; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007224:Infant Care / Q000379:methods*; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008880:Midwifery / Q000193:education*; D054238:Perinatal Mortality / Q000639:trends; D011247:Pregnancy; D012424:Rural Population / Q000706:statistics & numerical data; D012579:Schools, Nursing