for Zambias Mothers and Babies Two Neonatal Survival Intervention Studies Zambia Chlorhexidine Application Trial ZamCAT and Lufwanyama Neonatal Survival Project LUNESP Dr Godfrey ID: 536254
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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, ZCAHRDSlide2
What is ZCAHRD?A registered non-governmental Applied and Implementation Research Organization CompriseFaculty and staff of the Center for Global Health and Development (CGHD) at Boston University (USA) Zambian public health professionals and specialistsProject offices in Lusaka, Mazabuka, Choma, Kalomo, Livingstone.Central Office in LusakaSlide3
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 mortality
Target 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 3Slide4
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.4Slide5
Lufwanyama Neonatal Survival ProjectIn 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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6Neonatal 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 INTERVENTIONSlide7
7Results: Primary Endpoint
Cumulative All-Cause Mortality By Day 28Slide8
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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 MonthSlide9
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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AcknowledgementsArthur Mazimba, David Hamer, Katherine Semrau and the rest of ZamCAT teamChris Gill, David Hamer, Kojo Yeboah-Anwti and the rest of LUNESP teamDonors: BMGF, USAID10
ZIKOMO!TWALUMBA! LUITUMEZI!TWATASHA!