Impact of a Nursing Skill-Improvement Intervention on Newborn-Specific Delivery Practices: An Experience from Bihar, India.
High neonatal mortality in India had previously been attributed to the low proportion of institutional deliveries. However, a significant rise in the proportion of facility-based births over the last decade has not achieved the desired reduction in neonatal mortality possibly as a result of low-skilled care at facilities. This study evaluated the effectiveness of "Mobile Nurse Training," a knowledge-based intervention for nurses to improve essential newborn-specific delivery practices.



Eighty health centers with obstetric care facilities were selected from eight districts of Bihar. The intervention teams were composed of two trained nurses who conducted a week-long workshop per month at every health facility for 6 months. An independent evaluation team conducted baseline and postintervention assessments at every facility. The assessments included passive observation of newborn-specific delivery practices and recording of results on a preformatted checklist-based tool.



The intervention was associated with significant increases in the odds of four recommended practices: placing the newborn on mother's abdomen (adjusted odds ratio (AOR) 4.2 [95% CI 3.0-5.9]), wiping the eyes with sterile gauze (AOR 2.2 [95% CI 1.4-3.4]), skin-to-skin care (AOR 2.7 [95% CI 2.0-3.5]), and guidance for initiation of breastfeeding (AOR 1.6 [95% CI 1.2-2.1]). The intervention was also found to be positively associated with the summary score for improvements in all newborn-specific delivery practices. One year after the intervention, the summary practice score remained higher than at baseline, but with some decline over time.



The "Mobile Nurse Training" intervention provides a pathway for improving adherence to recommended newborn-specific delivery practices among institutional birth attendants in rural Bihar.
CARE India Solutions for Sustainable Development, Patna, Bihar, India.
Aritra
A
Das
CARE India Solutions for Sustainable Development, Patna, Bihar, India.
Dipty
D
Nawal
CARE India Solutions for Sustainable Development, Patna, Bihar, India.
Manoj K
MK
Singh
CARE India Solutions for Sustainable Development, Patna, Bihar, India.
Morchan
M
Karthick
CARE India Solutions for Sustainable Development, Patna, Bihar, India.
Parika
P
Pahwa
CARE India Solutions for Sustainable Development, Patna, Bihar, India.
Malay B
MB
Shah
Department of Epidemiology, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, CA, USA.
Tanmay
T
Mahapatra
CARE India Solutions for Sustainable Development, Patna, Bihar, India.
Indrajit
I
Chaudhuri
D016009:Chi-Square Distribution; D002983:Clinical Competence; D036861:Delivery, Obstetric / Q000401:mortality / Q000451:nursing*; D004509:Education, Nursing, Continuing / Q000379:methods; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008428:Maternal Mortality / Q000639:trends; D017283:Neonatal Nursing / Q000193:education*; D016017:Odds Ratio; D036801:Parturition; D011247:Pregnancy; D058996:Quality Improvement
India; neonatal mortality; newborn care; quality of care; rural health