title: Improving newborn care practices through home visits: lessons from Malawi, Nepal, Bangladesh, and Uganda.
abstract: BACKGROUND
  Nearly all newborn deaths occur in low- or middle-income countries. Many of these deaths could be prevented through promotion and provision of newborn care practices such as thermal care, early and exclusive breastfeeding, and hygienic cord care. Home visit programmes promoting these practices were piloted in Malawi, Nepal, Bangladesh, and Uganda.
  
  
  OBJECTIVE
  This study assessed changes in selected newborn care practices over time in pilot programme areas in four countries and evaluated whether women who received home visits during pregnancy were more likely to report use of three key practices.
  
  
  METHODS
  Using data from cross-sectional surveys of women with live births at baseline and endline, the Pearson chi-squared test was used to assess changes over time. Generalised linear models were used to assess the relationship between the main independent variable - home visit from a community health worker (CHW) during pregnancy (0, 1-2, 3+) - and use of selected practices while controlling for antenatal care, place of delivery, and maternal age and education.
  
  
  RESULTS
  There were statistically significant improvements in practices, except applying nothing to the cord in Malawi and early initiation of breastfeeding in Bangladesh. In Malawi, Nepal, and Bangladesh, women who were visited by a CHW three or more times during pregnancy were more likely to report use of selected practices. Women who delivered in a facility were also more likely to report use of selected practices in Malawi, Nepal, and Uganda; association with place of birth was not examined in Bangladesh because only women who delivered outside a facility were asked about these practices.
  
  
  CONCLUSIONS
  Home visits can play a role in improving practices in different settings. Multiple interactions are needed, so programmes need to investigate the most appropriate and efficient ways to reach families and promote newborn care practices. Meanwhile, programmes must take advantage of increasing facility delivery rates to ensure that all babies benefit from these practices.
authors.affiliation: Save the Children, Washington, DC, USA; dsitrin@savechildren.org.
authors.forename: Deborah
authors.initials: D
authors.lastname: Sitrin
authors.affiliation: Save the Children, Washington, DC, USA.
authors.forename: Tanya
authors.initials: T
authors.lastname: Guenther
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Waiswa
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Sarah
authors.initials: S
authors.lastname: Namutamba
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: Gertrude
authors.initials: G
authors.lastname: Namazzi
authors.affiliation: Save the Children, Kathmandu, Nepal.
authors.forename: Srijana
authors.initials: S
authors.lastname: Sharma
authors.affiliation: UNICEF, Kathmandu, Nepal.
authors.forename: K C
authors.initials: KC
authors.lastname: Ashish
authors.affiliation: Save the Children, Dhaka, Bangladesh.
authors.forename: Sayed
authors.initials: S
authors.lastname: Rubayet
authors.affiliation: National Institute of Population Research and Training, Ministry of Health and Family Welfare, Dhaka, Bangladesh.
authors.forename: Subrata
authors.initials: S
authors.lastname: Bhadra
authors.affiliation: Save the Children, Lilongwe, Malawi.
authors.forename: Reuben
authors.initials: R
authors.lastname: Ligowe
authors.affiliation: Save the Children, Lilongwe, Malawi.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Chimbalanga
authors.affiliation: Department of Neonatology, Children's National Medical Center, Washington, DC, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sewell
authors.affiliation: Save the Children, Cape Town, South Africa.
authors.forename: Kate
authors.initials: K
authors.lastname: Kerber
authors.affiliation: Save the Children, Washington, DC, USA.
authors.forename: Allisyn
authors.initials: A
authors.lastname: Moran
mesh_terms: D000328:Adult; D001459:Bangladesh; D002662:Child Health Services / Q000458:organization & administration*; D003150:Community Health Workers / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D006293:Health Promotion / Q000458:organization & administration; D006792:House Calls; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods / Q000458:organization & administration*; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D008875:Middle Aged; D009390:Nepal; D010865:Pilot Projects; D049590:Postpartum Period; D011247:Pregnancy; D014454:Uganda; D014932:Women's Health Services / Q000458:organization & administration*; D055815:Young Adult
keywords: community health worker; community-based; home visit; neonatal; newborn; postnatal
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