Maternal and Newborn Health Conference

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for Zambia’s Mothers and Babies. Two Neonatal Survival Intervention Studies: Zambia . Chlorhexidine. Application Trial (. ZamCAT. ) and . Lufwanyama. Neonatal Survival Project (LUNESP). Dr. Godfrey . ID: 536254 Download Presentation

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Maternal and Newborn Health Conference




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Slide1

Maternal and Newborn Health Conference for Zambia’s Mothers and Babies

Two Neonatal Survival Intervention Studies: Zambia Chlorhexidine Application Trial (ZamCAT) and Lufwanyama Neonatal Survival Project (LUNESP)

Dr. Godfrey

Biemba

,

MBChB

,

M.Sc

Research Assistant Professor, Boston University

Country Director, ZCAHRD

Slide2

What is ZCAHRD?

A

registered non-governmental A

pplied and Implementation Research

O

rganization

Comprise

Faculty

and staff of the Center for Global Health and Development (CGHD) at Boston University (USA)

Zambian

public health professionals and

specialists

Project offices in Lusaka

,

Mazabuka

,

Choma

,

Kalomo

, Livingstone.

Central Office in Lusaka

Slide3

Zambia Chlorhexidine Application Trial (ZamCAT)

Cluster-randomized controlled effectiveness trial comparing:Daily cord cleansing with 4% chlorhexidine toDry cord care (MoH guided standard practice)Primary outcome = neonatal mortalityTarget sample size = 42,500 mother/baby pairsRecruit pregnant women from 24 weeks gestation during ANC at facility or during outreachTotal of 9 visits are made per participant post enrollment/consenting (4=prenatal & 5=postnatal). Six Districts of Southern Province (Choma, Monze, Mazabuka, Kalomo, Livingstone & Siavonga) with a total of 90 clusters

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Zambia Chlorhexidine Application Trial (ZamCAT)

Part of an Alliance for Maternal and Newborn Health Improvement (AMANHI)Multi-country study that aims to generate unique information to guide improvements on interventions to reduce maternal and newborn mortality and morbidity, and to prevent stillbirthsProgress:>35,000 pregnant women enrolled; 28,000 deliveries; >25,000 completed studyUnder AMANHI, 270 female data collectors have been trained to (as part of maternal morbidity screening): Determine EDD using pregnancy wheelsMeasure urine protein using urine dipsticksMeasure BP using portable microlife BP machines.

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Lufwanyama Neonatal Survival Project

In communities with limited access to health care, is it possible to reduce neonatal mortality by training TBAs in skills that address some of the most important causes of neonatal mortality, notably birth asphyxia, neonatal hypothermia, and neonatal sepsis?Cluster randomized, controlled effectiveness trial Cluster= ‘All infants delivered by a given TBA’Intervention: TBAs trained in NRP and antibiotics/facilitated referral (AFR) at baseline with refresher training every 3-4monthsControl: TBAs providing existing standard of carePrimary endpoint: Mortality at 28 days of life among live-born infantsAdditional endpoints:Stillbirth rates, mortality rates at different times during 28 daysCause of death analysis based on verbal autopsiesReviewed by 3 neonatologists, blinded to allocation group

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Neonatal resuscitation Program (NRP)Skills Prevention of hypothermiaClear airwayPosition airwayProper stimulation when neededRescue breathing when neededEquipmentTwo flannel blankets/deliveryRubber bulb syringe/deliveryLaerdal maskLaminated reference card (front)

Antibiotics with facilitated referral (AFR)SkillsIdentification of trigger conditionsSingle dose oral amoxicillinAccompany mother/infant pair to nearest health facilityEquipment, drugs and suppliesTwo 250 mg amoxicillin capsulesMixing cup/spoonOral syringeBottle with chlorinated water Laminated reference card (back)

COMPONENTS OF THE INTERVENTION

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Results: Primary EndpointCumulative All-Cause Mortality By Day 28

Slide8

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Death Rate on Day of Delivery:

19.9/1000 births (control) vs. 7.8/1000 births (intervention)

RR = 0.4, 95% CI 0.19-0.83

LUNESP RESULTS :

Timing of Deaths During First Month

Slide9

LUNESP Conclusions

Intervention was highly effective at reducing neonatal mortality 45% reduction in all-cause mortality by day 28 (Primary Endpoint) Decreased neonatal mortality rate by 18 per 1000 live births Note: Zambia national average: 34 deaths per 1000 live births 1 death averted per 56 deliveries attended by an intervention TBALargest impact in earliest days of life Day of birth: 60% reduction Week one: 44% reduction Weeks 2-4: non-significant trendNRP appeared to be the most effective component of interventions Birth asphyxia deaths reduced by 70-80% No difference in sepsis deaths No difference in other causes of death

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Slide10

Acknowledgements

Arthur Mazimba, David Hamer, Katherine Semrau and the rest of ZamCAT teamChris Gill, David Hamer, Kojo Yeboah-Anwti and the rest of LUNESP teamDonors: BMGF, USAID

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ZIKOMO!

TWALUMBA!

LUITUMEZI!

TWATASHA!


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