Effect of timing of first postnatal care home visit on neonatal mortality in Bangladesh: a observational cohort study

doi:10.1136/bmj.b2826

Published 14 August 2009, doi:10.1136/bmj.b2826
Cite this as: BMJ 2009;339:b2826

Research

Effect of timing of first postnatal care home visit on neonatal mortality in Bangladesh: a observational cohort study

Abdullah H Baqui, associate professor¹^,3, Saifuddin Ahmed, associate professor², Shams El Arifeen, senior scientist and unit head³, Gary L Darmstadt, interim deputy director¹^,4, Amanda M Rosecrans, senior research assistant ¹, Ishtiaq Mannan, fellow¹, Syed M Rahman, deputy project coordinator ³, Nazma Begum, analyst programmer³, Arif B A Mahmud, project research manager³, Habibur R Seraji, project coordinator³, Emma K Williams, research associate ¹, Peter J Winch, associate professor¹, Mathuram Santosham, professor ¹, Robert E Black, professor¹, for the Projahnmo 1 Study Group

¹ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA , ² Department of Population and Family Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA , ³ International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka 1000, Bangladesh , ⁴ Global Health Program, Bill and Melinda Gates Foundation, Seattle, WA 98102, USA

Correspondence to: A H Baqui abaqui{at}jhsph.edu

Objective To assess the effect of the timing of first postnatalhome visit by community health workers on neonatal mortality.

Design Analysis of prospectively collected data using time varyingdiscrete hazard models to estimate hazard ratios for neonatalmortality according to day of first postnatal home visit.

Data source Data from a community based trial of neonatal careinterventions conducted in Bangladesh during 2004-5.

Main outcome measure Neonatal mortality.

Results 9211 live births were included. Among infants who survivedthe first day of life, neonatal mortality was 67% lower in thosewho received a visit on day one than in those who received novisit (adjusted hazard ratio 0.33, 95% confidence interval 0.23to 0.46; P<0.001). For those infants who survived the firsttwo days of life, receiving the first visit on the second daywas associated with a 64% lower neonatal mortality than in thosewho did not receive a visit (adjusted hazard ratio 0.36, 0.23to 0.55; P<0.001). First visits on any day after the secondday of life were not associated with reduced mortality.

Conclusions In developing countries, especially where home deliverywith unskilled attendants is common, postnatal home visits withinthe first two days of life by trained community health workerscan significantly reduce neonatal mortality.

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