Murthy Seema, Yan Shirley Du, Alam Shahed, Kumar Amit, Rangarajan Arjun, Sawant Meenal, Sulaiman Huma, Yadav Bhanu Pratap, Singh Pathani Tanmay, Kumar H G Anand, Kak Sareen, A M Vinayaka, Kaur Baljit, N Rajkumar, Mishra Archana, Elliott Edith, Delaney Megan Marx, Semrau Katherine E A
Aurora Health Innovations, Bengaluru, India.
Noora Health, San Francisco, California, United States of America.
PLOS Glob Public Health. 2023 May 25;3(5):e0001240. doi: 10.1371/journal.pgph.0001240. eCollection 2023.
Despite the global decline, neonatal mortality rates (NMR) remain high in India. Family members are often responsible for the postpartum care of neonates and mothers. Yet, low health literacy and varied beliefs can lead to poor health outcomes. Postpartum education for family caregivers, may improve the adoption of evidence-based neonatal care and health outcomes. The Care Companion Program (CCP) is a hospital-based, pre-discharge health training session where nurses teach key healthy behaviors to mothers and family members, including skills and an opportunity to practice them in the hospital. We conducted a quasi-experimental study to assess the effect of the CCP sessions on mortality outcomes among families seeking care in 28 public tertiary facilities across 4 Indian states. Neonatal mortality outcomes were reported post-discharge, collected via phone surveys at four weeks postpartum, between October 2018 to February 2020. Risk ratios (RR), adjusting for hospital-level clustering, were calculated by comparing mortality rates before and after CCP implementation. A total of 46,428 families participated in the pre-intervention group and 87,305 in the post-intervention group; 76% of families completed the phone survey. Among the 33,599 newborns born before the CCP implementation, there were 1386 deaths (NMR: 41.3 deaths per 1000 live births). After the intervention began, there were 2021 deaths out of 60,078 newborns born (crude NMR: 33.6 deaths per 1000 live births, RR = 0.82, 95% CI: 0.76, 0.87; cluster-adjusted RR = 0.82, 95% CI: 0.71, 0.94). There may be a substantial benefit to family-centered education in the early postnatal period to reduce neonatal mortality.
尽管全球新生儿死亡率呈下降趋势，但印度的新生儿死亡率仍然很高。家庭成员通常负责新生儿和母亲的产后护理。然而，健康素养低和信仰各异可能导致不良的健康结果。为家庭护理人员提供产后教育，可能会促进循证新生儿护理的采用并改善健康结果。护理陪伴计划（CCP）是一项在医院进行的出院前健康培训课程，护士会向母亲和家庭成员传授关键的健康行为，包括相关技能并提供在医院练习的机会。我们进行了一项准实验研究，以评估CCP课程对在印度4个邦的28家公立三级医疗机构寻求护理的家庭的死亡率结果的影响。出院后报告新生儿死亡率结果，于2018年10月至2020年2月通过产后四周的电话调查收集。通过比较CCP实施前后的死亡率，计算了调整医院层面聚类后的风险比（RR）。共有46,428个家庭参与了干预前组，87,305个家庭参与了干预后组；76%的家庭完成了电话调查。在CCP实施前出生的33,599名新生儿中，有1386例死亡（新生儿死亡率：每1000例活产中有41.3例死亡）。干预开始后，在出生的60,078名新生儿中有2021例死亡（粗新生儿死亡率：每1000例活产中有33.6例死亡，RR = 0.82，95%置信区间：0.76，0.87；聚类调整后的RR = 0.82，95%置信区间：0.71，0.94）。产后早期以家庭为中心的教育对于降低新生儿死亡率可能有很大益处。
