title: Effect of implementation of integrated management of neonatal and childhood illness programme on treatment seeking practices for morbidities in infants: cluster randomised trial.
abstract: OBJECTIVE
  To determine the effect of implementation of the Integrated Management of Neonatal and Childhood Illness strategy on treatment seeking practices and on neonatal and infant morbidity.
  
  
  METHODS
  Cluster randomised trial.
  
  
  METHODS
  Haryana, India.
  
  
  METHODS
  29,667 births in nine intervention clusters and 30,813 births in nine control clusters.
  
  
  METHODS
  The pre-specified outcome was the effect on treatment seeking practices. Post hoc exploratory analyses assessed morbidity, hospital admission, post-neonatal infant care, and nutritional status outcomes.
  
  
  METHODS
  The Integrated Management of Neonatal and Childhood Illness intervention included home visits by community health workers, improved case management of sick children, and strengthening of health systems. Outcomes were ascertained through interviews with randomly selected caregivers: 6204, 3073, and 2045 in intervention clusters and 6163, 3048, and 2017 in control clusters at ages 29 days, 6 months, and 12 months, respectively.
  
  
  RESULTS
  In the intervention cluster, treatment was sought more often from an appropriate provider for severe neonatal illness (risk ratio 1.76, 95% confidence interval 1.38 to 2.24), for local neonatal infection (4.86, 3.80 to 6.21), and for diarrhoea at 6 months (1.96, 1.38 to 2.79) and 12 months (1.22, 1.06 to 1.42) and pneumonia at 6 months (2.09, 1.31 to 3.33) and 12 months (1.44, 1.00 to 2.08). Intervention mothers reported fewer episodes of severe neonatal illness (risk ratio 0.82, 0.67 to 0.99) and lower prevalence of diarrhoea (0.71, 0.60 to 0.83) and pneumonia (0.73, 0.52 to 1.04) in the two weeks preceding the 6 month interview and of diarrhoea (0.63, 0.49 to 0.80) and pneumonia (0.60, 0.46 to 0.78) in the two weeks preceding the 12 month interview. Infants in the intervention clusters were more likely to still be exclusively breast fed in the sixth month of life (risk ratio 3.19, 2.67 to 3.81).
  
  
  CONCLUSIONS
  Implementation of the Integrated Management of Neonatal and Childhood Illness programme was associated with timely treatment seeking from appropriate providers and reduced morbidity, a likely explanation for the reduction in mortality observed following implementation of the programme in this study.Trial registration Clinical trials NCT00474981; ICMR Clinical Trial Registry CTRI/2009/091/000715.
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi 110016, India.
authors.forename: Sarmila
authors.initials: S
authors.lastname: Mazumder
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi 110016, India.
authors.forename: Sunita
authors.initials: S
authors.lastname: Taneja
authors.affiliation: Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Bahl
authors.affiliation: UNICEF India Country Office, New Delhi, India.
authors.forename: Pavitra
authors.initials: P
authors.lastname: Mohan
authors.affiliation: Centre for International Health, University of Bergen, Norway.
authors.forename: Tor A
authors.initials: TA
authors.lastname: Strand
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Betty R
authors.initials: BR
authors.lastname: Kirkwood
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi 110016, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Goyal
authors.affiliation: UNICEF India Country Office, New Delhi, India.
authors.forename: Henri
authors.initials: H
authors.lastname: Van Den Hombergh
authors.affiliation: Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Norway.
authors.forename: Jose
authors.initials: J
authors.lastname: Martines
authors.affiliation: Centre for Health Research and Development, Society for Applied Studies, New Delhi 110016, India CHRD@sas.org.in.
authors.forename: Nita
authors.initials: N
authors.lastname: Bhandari
mesh_terms: D019090:Case Management; D003153:Community Health Services / Q000379:methods*; D003150:Community Health Workers; D005260:Female; D006792:House Calls; D006801:Humans; D007194:India; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009035:Mothers / Q000193:education*; D010342:Patient Acceptance of Health Care; D061665:Time-to-Treatment