A combination of strategies aimed at improving the quality of care for mothers in rural Malawi has dramatically reduced newborn mortality. Experts say it could be a model for similar programs in other countries with poor pre- and post-natal care.
The five-year program looked at the care of women and their newborns in the weeks immediately preceding and following birth in Malawi, a sub-Saharan country with one of the highest infant mortality rates in the world.
The study was carried out in three rural communities, with a combined population of 2 million people. Investigators wanted to find out which of two interventions was more effective in reducing newborn and infant mortality - improving health care quality at birthing facilities or community involvement in helping the mother get the professional care she needed.
In the end, Tim Colbourn, a population expert at University College London, says employing the two interventions together was more effective than either strategy alone in saving newborn lives during the first month of life.
Colbourn, who analyzed the data, says investigators found a 30 percent reduction in neonatal mortality by the time the program was fully implemented, saving at least 1,000 newborn lives.
Speaking via Skype, Colbourn pointed to the importance of training workers at health clinics in the technique known as "kangaroo care." In Western countries, he says, distressed newborns would be put in a climate-controlled incubator under the constant watch of medical personnel.
"But that's just simply not affordable and possible in some of these health facilities in Malawi. So, instead, the mother takes the baby and places the baby on her chest and rocks the baby and keeps the baby warm constantly, which really helps improve the baby's survival," said Colbourn.
On the community care side, residents were taught to recognize when distressed mothers-to-be needed emergency medical care. Someone could then rush her to a clinic or health care facility in a “bicycle ambulance,” pedal carts that pull a padded wagon that allows pregnant women to rest in a reclining position, before she develops potentially lethal complications.
Colbourn says the World Health Organization and other NGOs are evaluating the Maikanda approach, which means “mother baby” in the native Chichawa language, in other low income countries.
“There’s already been a lot of work done on that in India, Nepal and Bangladesh, and we’ve analyzed the results from other trials my colleagues have been involved in. And that’s been found to reduce neonatal and maternal mortality to quite a large extent," he said.
However, the Malawi trial did not show a significant reduction in maternal mortality.
The study was funded and carried out by the non-governmental Health Foundation with support by partners in the U.S. and Britain.
Researchers hope efforts like Maikanda will help other countries achieve the United Nations Millennium Development Goal of reducing child mortality by two-thirds by 2015.