Powerpoint template for scientific posters (Swarthmore College)

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Community mobilization and behavior change
communication promotes adoption of evidence-based
essential newborn care practices and reduces
neonatal mortality in Uttar Pradesh,
India Darmstadt GL,1,2 Kumar V,1,3 Singh P,3
Singh V,3 Yadav R,3 Mohanty S,3 Bharti N,3 Gupta
S,3 Mishra RP,3 Baqui AH,1 Gupta A,3 Awasthi
S,3,4 Singh JV,3 Ahuja RC,3 Winch PJ,1 Santosham
M1 1Department of International Health,
Bloomberg School of Public Health, Johns Hopkins
University, Baltimore, MD, USA 2Save the
Children-US, Washington, DC, USA 3KGMC Institute
of Clinical Epidemiology, 4Department of
Pediatrics and 5Department of Social and
Preventive Medicine, King George Medical
University, Lucknow, India
Findings Changes in practices
Study Site Shivgarh

Introduction Millennium Development Goal-4 for
child survival cannot be met without substantial
reductions in neonatal mortality (Lawn JE et al.
Lancet 2005 365891-900). Every year an
estimated 4 million infants die in the first 28
days of life. India accounts for 27 of global
neonatal deaths, and 30 of neonatal mortality in
India occurs in the state of Uttar Pradesh (UP).
The majority of births and neonatal deaths take
place at home, away from the reach of skilled
providers. Thus, innovative community-based
approaches are urgently needed to bring
substantial improvement in newborn survival in
India.
Findings Reduced mortality
Table 1. Study site characteristics
Table 2. Impact on stillbirths, perinatal and
neonatal mortality (1,2 per 1000 live births)
(c)
(b)
Figure 1. Neonatal deaths in the state of UP,
India, in comparison to other countries

• Intervention
• The intervention strategy and BCC package was
  developed based on formative research and trials
  of improved practices (TIPS). The approach
  adopted was
• Community mobilization
• Culturally appropriate BCC
• Community-based workers (Saksham Sahayak) to
  deliver BCC messages to pregnant women, their
  family members and key community stake-holders
  through home visitations
• Develop and progressively transfer intervention
  responsibilities to community volunteers (Saksham
  Karta)

(a)
Figure 4. Increased acceptance of skin-to-skin
care
Objectives 1) To develop and evaluate a
community-based, community-driven program to
deliver the Family Package of interventions
(Darmstadt GL, et al. Lancet 2005
365977-988). 2) To determine cost and impact on
domiciliary care practices, care-seeking and
neonatal mortality in a low-resource,
high-mortality setting in rural Uttar Pradesh,
India, with a poorly functioning health system.
Study Design Cluster-randomized controlled
trial in a rural development block (Shivgarh)
with 104,000 population Gram Sabha (cluster of
contiguous villages) as the unit of
randomization. 39 Gram Sabhas were randomly
allocated to one of three study arms I
Comparison (usual care) II CM BCC III CM
BCC TS CM Community Mobilization BCC
Behavior Change Communication TS ThermoSpot
(hypothermia indicator)
Figure 7. Survival curves
Panel 1. BCC Package
Conclusion Community mobilization and behavior
change communications which avoid conflict with
deep-rooted social and cultural values and roles
appear to act together to stimulate the adoption
of evidence-based newborn care practices, leading
to reduced neonatal mortality. Policy
Implications In high mortality settings with
poorly functioning health systems, initial
emphasis on promotion of evidence-based family
and community essential newborn care can rapidly
improve care practices and substantially lower
neonatal mortality, but community demand requires
simultaneous attention to clinical care for
maternal and newborn complications.

• Birth preparedness
• Clean delivery
• Immediate breastfeeding
• Skin-to-skin care (STSC)
• Thermal care
• Hygienic cord care and skin care

Figure 5. Increased initiation of breastfeeding
on day 0

• The Saksham Sahayak developed a cadre of
  volunteers (Saksham Karta) who complemented their
  role. The latter consisted of mothers who
  benefited from the intervention and influential
  members of the community who have a stake in
  newborn care and have volunteered to disseminate
  and support modification and adoption of
  evidence-based behaviors by family members.

Acknowledgements Community of Shivgarh
Figure 6. Deceased bathing on day 0
Figure 2. View of Shivgarh with allocated Gram
Sabhas
Figure 3. Overview of Intervention visits and
data collection