title: Effects of Essential Newborn Care Training on Fresh Stillbirths and Early Neonatal Deaths by Maternal Education.
abstract: Infants of women with lower education levels are at higher risk for perinatal mortality.
  
  
  
  We explored the impact of training birth attendants and pregnant women in the Essential Newborn Care (ENC) Program on fresh stillbirths (FSBs) and early (7-day) neonatal deaths (END) by maternal education level in developing countries.
  
  
  
  A train-the-trainer model was used with local instructors in rural communities in six countries (Argentina, Democratic Republic of the Congo, Guatemala, India, Pakistan, and Zambia). Data were collected using a pre-/post-active baseline controlled study design.
  
  
  
  A total of 57,643 infants/mothers were enrolled. The follow-up rate at 7 days of age was 99.2%. The risk for FSB and END was higher for mothers with 0-7 years of education than for those with ≥8 years of education during both the pre- and post-ENC periods in unadjusted models and in models adjusted for confounding. The effect of ENC differed as a function of maternal education for FSB (interaction p = 0.041) without evidence that the effect of ENC differed as a function of maternal education for END. The model-based estimate of FSB risk was reduced among mothers with 0-7 years of education (19.7/1,000 live births pre-ENC, CI: 16.3, 23.0 vs. 12.2/1,000 live births post-ENC, CI: 16.3, 23.0, p < 0.001), but was not significantly different for mothers with ≥8 years of education, respectively.
  
  
  
  A low level of maternal education was associated with higher risk for FSB and END. ENC training was more effective in reducing FSB among mothers with low education levels.
authors.affiliation: University of Alabama at Birmingham, Birmingham, Ala., USA.
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Wally A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.forename: Imtiaz
authors.initials: I
authors.lastname: Jehan
authors.forename: Antoinette
authors.initials: A
authors.lastname: Tshefu
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.forename: Sailajandan
authors.initials: S
authors.lastname: Parida
authors.forename: Fernando
authors.initials: F
authors.lastname: Althabe
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Carl
authors.initials: C
authors.lastname: Bose
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Krebs
authors.forename: Pinaki
authors.initials: P
authors.lastname: Panigrahi
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
authors.forename: Dennis
authors.initials: D
authors.lastname: Wallace
authors.forename: Janet
authors.initials: J
authors.lastname: Moore
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
mesh_terms: D000328:Adult; D000349:Africa; D001208:Asia; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000592:standards*; D007843:Latin America; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D018570:Risk Assessment; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult