Stillbirths Drop After Newborn Care Training in Developing Countries, Study Finds

RESEARCH TRIANGLE PARK, N.C. — The rate of stillbirths in rural areas of six developing countries fell more than 30 percent following a basic training program in newborn care for birth attendants, according to a study funded by the National Institutes of Health and the Bill and Melinda Gates Foundation.

RTI International served as the data coordinating center for the study that was published in the February 21 issue of The New England Journal of Medicine.

The study tracked more than 120,000 births, testing the efficacy of a three-day Essential Newborn Care training regimen developed by the World Health Organization.

The training taught health care workers in rural communities—physicians, nurses, midwives, and birth attendants—ventilation and resuscitation techniques, the importance of early breastfeeding, how to keep infants warm and dry, and signs of danger. The study, the largest of its kind, is one of the first to track the rate of infant deaths following the implementation of such a regimen.

"These findings suggest that a comparatively low-cost instructional regimen for birth attendants can be effective in reducing stillbirths in parts of the world where most births are not attended by a physician," said Alan E. Guttmacher, M.D., acting director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the NIH institute that, along with the Bill and Melinda Gates Foundation, funded the study.

The study authors found that the overall rate of infant death during the first seven days of life did not change among infants who had been administered the essential newborn care regimen. However, the rate of stillbirths dropped sharply—from 23 per 1,000 deliveries to 15.9 per 1,000.

The greatest decrease in stillbirth rates was among deliveries attended by nurses, midwives, and traditional attendants, who, the researchers believe, would likely not have received such training.

The study authors surmised that the essential newborn care training was most effective in providing attendants needed skills and expertise in newborn resuscitation. Upon close examination of the cases of stillbirth, they found a decrease in the rates of fresh stillbirth, or death immediately before or at the moment of birth. In contrast, the rate of stillbirth in which the fetus had died in the womb was unchanged.

WHO estimates that, in addition to more than 3 million stillbirths worldwide each year, nearly 4 million infants die in their first month of life.

The research was conducted at study sites in Argentina, the Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia as part of the Global Network for Women's and Children's Health Research. The network is a partnership of NICHD and the Bill and Melinda Gates Foundation.

"Our results show that training in essential newborn care can play a role in improving birth outcomes in the developing world," said Linda L. Wright, M.D., scientific director of the NICHD Global Network for Women's and Children's Health Research. "However, additional research is needed to extend the gains seen in this study through to a reduction in mortality during the newborn period."

In a subsequent phase of the study, trainers led in-depth sessions focused exclusively on neonatal resuscitation techniques in 88 randomly selected communities, where attendants had already undergone the Essential Newborn Care training program. But the researchers found this additional training did not further reduce infant mortality.

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RTI News Media Contacts
Email: news@rti.org
Lisa Bistreich: 919-316-3596
Patrick Gibbons: 919-541-6136