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Report: Strategy Drastically Reduces Newborn Death Rates in Rural Nepal - 2004-09-17

Health researchers report that they were able to reduce newborn death rates in rural Nepal by nearly one third, using a surprisingly simple strategy.

In the mid-1990s, pediatrician Andrew Costello of London's Institute of Child Health was part of a group studying how to reduce newborn and mother's deaths at a hospital in Katmandu, Nepal. He says the assumption was that if professional health workers tell people what to do, they'll do it. "And we were surprised to find that such an approach had very little effect, either on knowledge or attitudes or practices, let alone death rates," he says.

If that's the case in an urban setting, where health centers are nearby, Dr. Costello and his colleagues knew they'd have to try a different approach in places far from any health facility, places such as rural Nepal.

So they sent teams out to rural villages to find women with some education who were trusted in the local community. These women received brief training on common problems in pregnancy and birth, and on how to lead group discussions. These local women then organized a series of group meetings with other local women to identify and deal with pregnancy problems.

Dr. Costello says that when researchers compared villages that held the meetings to villages that didn't, they expected a modest health effect. "So we were really astonished when after a two and a half year period we looked at the data and found a 30 percent reduction in newborn deaths. And then even more astonished when we found that there was a nearly 80 percent reduction in maternal deaths," he says.

Dr. Costello says a larger study will be needed to confirm the figure on maternal deaths. The research appeared in The Lancet, a major British medical journal.

According to the authors, several factors contributed to the lower death rates. Women in villages with the group meetings were more likely to seek health care while they were pregnant. Birth attendants were more likely to wash their hands, and to use a boiled blade to cut the umbilical cord. And a greater percentage of women give birth at a health center or with a trained birth attendant, although those figures were still relatively small.

Dr. Costello says he's been to the group meetings, and when you see them in action you might understand why they work. "They're very funny, they're very lively. It starts with a lot of swapping stories, a bit of gossip. And then it gets very, very lively. When they get into the intensity of grappling with problems, the debates are extremely vigorous and interesting," he says.

Different solutions came out of those debates. Some groups developed ways to get pregnant women to a hospital by stretcher if complications arose. Some pooled money to pay for emergency treatment. Others put together safe home delivery kits with a bar of soap, a clean razor blade, and a clean plastic sheet for the mother to lie on.

Child health researcher Ardythe Morrow at the Children's Hospital Medical Center in Cincinnati, Ohio wrote a commentary accompanying Dr. Costello's study. She says the research shows that sometimes the best answers are the ones people come up with themselves. "When people really get a grasp on what they could do for themselves to improve their own families and improve the survival of their own children, the energy and dynamism that can come from that can be phenomenal. And what we have to learn how to do is to channel it," he says.

Dr. Costello says studies are under way in several other developing countries to see if the same approach can work in other settings and other cultures.