Trial reportBMJ open2016
Increasing access to care for sick newborns: evidence from the Ghana Newhints cluster-randomised controlled trial.
Trial report in BMJ open, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00623337 (Cluster Randomised Trial to Evaluate the Impact of Routine Home Visits to Provide a Package of Essential Newborn Care Interventions in the Third Trimester of Pregnancy and the 1st Week of Life on Neonatal Mortality in Rural Ghana), which is not on this map. Cited by 12 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Cluster Randomised Trial to Evaluate the Impact of Routine Home Visits to Provide a Package of Essential Newborn Care Interventions in the Third Trimester of Pregnancy and the 1st Week of Life on Neonatal Mortality in Rural Ghana
Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Community health workers and health equity in low- and middle-income countries: systematic review and recommendations for policy and practice.International journal for equity in health · 2022Pooled it
- Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries.The Cochrane database of systematic reviews · 2019Pooled it
- Half of the mothers had poor delivery referral practices in public hospitals of Bahir Dar City Northwest, Ethiopia.Frontiers in public health · 2025Article
- Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs.BMJ global health · 2024Article
- Health seeking behaviour and knowledge on neonatal danger signs among neonatal caregivers in Upper Denkyira East Municipality, Ghana.BMC pediatrics · 2024Article
- Article
- Hot fomentation of newborn fontanelles as an indigenous practice in Ghana: implications for policy and integrated community-based health care in Covid-19 pandemic and beyond.International journal for equity in health · 2023Review
- Training programs to improve identification of sick newborns and care-seeking from a health facility in low- and middle-income countries: a scoping review.BMC pregnancy and childbirth · 2021Article
- Article
- Health system redesign for maternal and newborn survival: rethinking care models to close the global equity gap.BMJ global health · 2020Review
- Impact of the community-based newborn care package in Nepal: a quasi-experimental evaluation.BMJ open · 2017Article
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo evaluate the impact of Newhints community-based surveillance volunteer (CBSV) assessments and referrals on access to care for sick newborns and on existing inequities in access.
designWe evaluated a prospective cohort nested within the Newhints cluster-randomised controlled trial.
settingCommunity-based intervention involving more than 750 000, predominantly rural, population in seven contiguous districts in the Brong-Ahafo Region, Ghana.
participantsParticipants were recently delivered women (from more than 120 000 women under surveillance) and their 16 168 liveborn babies. Qualitative in-depth interviews with referral narratives (IDIs) were conducted with 92 mothers, CBSVs and health facility front-desk and maternity/paediatrics ward staff.
interventionsNewhints trained and effectively supervised 475 CBSVs (existing within the Ghana Health Service) in 49 of 98 supervisory zones (clusters) to assess and refer newborns with any of the 10-key-danger signs to health facilities within the first week after birth; promote independent care seeking for sick newborns and problem-solve around barriers between November 2008 and December 2009. PRIMARY OUTCOMES: The main evaluation outcomes were rates of compliance with referrals and independent care seeking for newborn illnesses.
resultsOf 4006 sampled, 2795 (69.8%) recently delivered women received CBSV assessment visits and 279 (10.0%) newborns were referred with danger signs. Compliance with referrals was unprecedentedly high (86.0%) with women in the poorest quintile (Q1) complying better than the least poor (Q5):87.5%(Q1) vs 69.7%(Q5); p=0.038. Three-quarters went to hospitals; 18% were admitted and 58% received outpatient treatment. Some (24%) mothers were turned away at facilities and follow-on IDIs showed that some of these untreated babies subsequently died. Independent care seeking for severe newborn illness increased from 55.4% in control to 77.3% in Newhints zones, especially among Q1 where care seeking almost doubled (95.0% vs 48.6%; RR=1.94 (1.32, 2.84); p=0.001). Rates were the highest among rural residents but urban residents complied quicker.
conclusionsHome visits are feasible and a potentially pro-poor approach to link sick newborns to facilities. Its effectiveness in improving survival hinges on matched improvement in facility quality of care. TRIAL REGISTRATION NUMBER: NCT00623337.
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