title: Community based newborn care: a systematic review and metaanalysis of evidence: UNICEF-PHFI series on newborn and child health, India.
abstract: BACKGROUND
  The neonatal mortality rate (NMR) in India has remained virtually unchanged in the last 5 years. To achieve the Millennium Development Goal (MDG) 4 on child mortality (two thirds reduction from 1990 to 2015), it is essential to reduce NMR. A systematic review of the evidence on community-based intervention packages to reduce NMR is essential for advocacy and action to reach MDG-4.
  
  
  OBJECTIVE
  To assess the effect of community based neonatal care by community health workers (CHWs) on NMR in resource-limited settings.
  
  
  METHODS
  Systematic review and meta-analysis of controlled trials.
  
  
  METHODS
  Electronic databases and hand search of reviews, and abstracts and proceedings of conferences.
  
  
  RESULTS
  A total of 13 controlled trials involving about 192000 births were included in this systematic review. Community based neonatal care by CHWs was associated with reduced neonatal mortality in resource-limited settings [RR=0.73 (0.65 to 0.83); P<0.0001]. The identified studies were a heterogeneous mix with respect to the extent and quality of community based neonatal care provided and the characteristics of the CHWs delivering the intervention. There was no consistent effect of training duration of the health workers, type of intervention (home visitation versus community participatory action and learning), number of home visits done by CHWs, and provision of only preventive versus both preventive and therapeutic care. Limited data suggests that the ideal time for the first postnatal visit is the first two days of life. The interventions are highly effective when baseline NMR is above 50/1000 live births [RR=0.64(0.54 to 0.77)]. The interventions show a significant decrease in efficacy as the NMR drops below 50/1000 live births [RR=0.85 (0.73 to 0.99)], however is still substantial. NMR gains from home visitation approach are going to materialize only in the presence of high program coverage of 50% or more.
  
  
  CONCLUSIONS
  A significant decrease in NMR is possible by providing community based neonatal care in areas with high NMR by community health workers with a modest training duration and ensuring high program coverage with home visitation on the first two days of life.
authors.affiliation: Department of Pediatrics, Max Hospital, Gurgaon, Haryana, India. gogiasiddhartha@gmail.com
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Gogia
authors.forename: Siddarth
authors.initials: S
authors.lastname: Ramji
authors.forename: Piyush
authors.initials: P
authors.lastname: Gupta
authors.forename: Tarun
authors.initials: T
authors.lastname: Gera
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Shah
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Mathew
authors.forename: Pavitra
authors.initials: P
authors.lastname: Mohan
authors.forename: Rajmohan
authors.initials: R
authors.lastname: Panda
mesh_terms: D003153:Community Health Services / Q000379:methods*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India; D007224:Infant Care / Q000379:methods*; D007226:Infant Mortality; D007231:Infant, Newborn; D011181:Postnatal Care / Q000379:methods*; D011247:Pregnancy