Reduced incidence of maternal health conditions associated with the home-based newborn care intervention package in Rural Gadchiroli, India: a 13 years before – after comparison

Abstract

Background To evaluate the association between home-based neonatal care interventions and the incidence of maternal health conditions as well as to estimate the longitudinal trend of the incidence of maternal health conditions over 13 years in 39 villages of the field program area of the of home-based neonatal care from rural Gadchiroli, India. Methods This was a before-after comparative analysis of a program implemented in thirty-nine villages in Gadchiroli, India. The home-based newborn care interventions were incrementally introduced during the field trial (1995 – 1998) and continued as a service program until 2008. Over thirteen years (1995–2008), pregnant women were recruited and followed up from the seventh month of pregnancy to 28 days postpartum by trained female community health workers who made antenatal, natal and post-natal home visits, provided health education to mothers for behavior change, managed normal and sick neonates as well as encouraged seeking medical care when necessary. They recorded maternal symptoms and signs, which a physician supervisor verified. Based on these symptoms and signs, a computer algorithm diagnosed 20 different maternal health conditions. The incidence of these conditions in the first year (1995-96) was compared with the intervention’s last two years (2006 - 2008). Result The mean coverage of home-based newborn care, assessed on eight indicators, increased from 48.5% in 1995 – 96 to 87.1% in 2006 – 08. The proportion of women with any maternal health conditions during pregnancy reduced by 44.76% (P<0.001), during labor by 44.59% (P <0.001) and during the postpartum period by 77.82% (P<0.001). The mean number of maternal conditions per 100 women reduced by 69% (P<0.001). The need for emergency obstetric care was reduced by 78.83% (P<0.001). The proportion of women free of any maternal health condition increased from 32.9 % to 64.6 %. Conclusions Home-based neonatal care interventions were associated with a significant reduction in the incidence of maternal health conditions. Developing a dedicated package of home-based maternal care in combination with neonatal care may further improve maternal health.