Since the announcement in 2000 of the millennium development goals (MDGs), progress towards achieving these goals has resulted in considerable reductions in deaths from communicable diseases such as HIV, tuberculosis, and malaria (MDG 6); maternal mortality (MDG 5); and child deaths (MDG 4). Child deaths for instance have declined from more than 12 million in 1990 to 7.6 million in 2010.1 However, progress in reducing neonatal deaths—deaths within the first month of life—has lagged behind. Neonatal deaths now account for a greater proportion of global child deaths than ever before—nearly 41% of all deaths in children under 5 years occur during the neonatal period.2

In this context, the results of the linked trial by Bhandari and colleagues (doi:10.1136/bmj.e1634) are of particular interest and importance.3 It is the first study to evaluate India’s large and complex Integrated Management of Neonatal and Childhood Illness (IMNCI) programme, which is an approach to neonatal and child care that is being implemented across the country. Bhandari and colleagues evaluated the Indian IMNCI programme and …