title: Effect of implementation of Integrated Management of Neonatal and Childhood Illness (IMNCI) programme on neonatal and infant mortality: cluster randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the Indian Integrated Management of Neonatal and Childhood Illness (IMNCI) programme, which integrates improved treatment of illness for children with home visits for newborn care, to inform its scale-up.
  
  
  METHODS
  Cluster randomised trial.
  
  
  METHODS
  18 clusters (population 1.1 million) in Haryana, India.
  
  
  METHODS
  29,667 births in intervention clusters and 30,813 in control clusters.
  
  
  METHODS
  Community health workers were trained to conduct postnatal home visits and women's group meetings; physicians, nurses, and community health workers were trained to treat or refer sick newborns and children; supply of drugs and supervision were strengthened.
  
  
  METHODS
  Neonatal and infant mortality; newborn care practices.
  
  
  RESULTS
  The infant mortality rate (adjusted hazard ratio 0.85, 95% confidence interval 0.77 to 0.94) and the neonatal mortality rate beyond the first 24 hours (adjusted hazard ratio 0.86, 0.79 to 0.95) were significantly lower in the intervention clusters than in control clusters. The adjusted hazard ratio for neonatal mortality rate was 0.91 (0.80 to 1.03). A significant interaction was found between the place of birth and the effect of the intervention for all mortality outcomes except post-neonatal mortality rate. The neonatal mortality rate was significantly lower in the intervention clusters in the subgroup born at home (adjusted hazard ratio 0.80, 0.68 to 0.93) but not in the subgroup born in a health facility (1.06, 0.91 to 1.23) (P value for interaction = 0.001). Optimal newborn care practices were significantly more common in the intervention clusters.
  
  
  CONCLUSIONS
  Implementation of the IMNCI resulted in substantial improvement in infant survival and in neonatal survival in those born at home. The IMNCI should be a part of India's strategy to achieve the millennium development goal on child survival.
  
  
  BACKGROUND
  Clinical trials NCT00474981; ICMR Clinical Trial Registry CTRI/2009/091/000715.
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, 45 Kalu Sarai, New Delhi 110016, India. CHRD@sas.org.in
authors.forename: Nita
authors.initials: N
authors.lastname: Bhandari
authors.forename: Sarmila
authors.initials: S
authors.lastname: Mazumder
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.forename: Tor A
authors.initials: TA
authors.lastname: Strand
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services / Q000379:methods* / Q000458:organization & administration; D016000:Cluster Analysis; D003150:Community Health Workers / Q000458:organization & administration / Q000592:standards; D003906:Developing Countries; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data; D006792:House Calls; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007224:Infant Care / Q000379:methods; D007226:Infant Mortality; D007231:Infant, Newborn; D057194:Intention to Treat Analysis; D010342:Patient Acceptance of Health Care; D054238:Perinatal Mortality; D011181:Postnatal Care; D011247:Pregnancy; D015397:Program Evaluation; D016016:Proportional Hazards Models; D012923:Social Class; D050497:Stillbirth / Q000453:epidemiology