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Randomized Controlled Trial
. 2012 Mar 21:344:e1634.
doi: 10.1136/bmj.e1634.

Effect of implementation of Integrated Management of Neonatal and Childhood Illness (IMNCI) programme on neonatal and infant mortality: cluster randomised controlled trial

Nita Bhandari  1 , Sarmila Mazumder, Sunita Taneja, Halvor Sommerfelt, Tor A Strand; IMNCI Evaluation Study Group
Collaborators, Affiliations
Randomized Controlled Trial

Effect of implementation of Integrated Management of Neonatal and Childhood Illness (IMNCI) programme on neonatal and infant mortality: cluster randomised controlled trial

Nita Bhandari et al. BMJ. .

Abstract

Objective: To evaluate the Indian Integrated Management of Neonatal and Childhood Illness (IMNCI) programme, which integrates improved treatment of illness for children with home visits for newborn care, to inform its scale-up.

Design: Cluster randomised trial.

Setting: 18 clusters (population 1.1 million) in Haryana, India.

Participants: 29,667 births in intervention clusters and 30,813 in control clusters.

Intervention: Community health workers were trained to conduct postnatal home visits and women's group meetings; physicians, nurses, and community health workers were trained to treat or refer sick newborns and children; supply of drugs and supervision were strengthened.

Main outcome measures: Neonatal and infant mortality; newborn care practices.

Results: The infant mortality rate (adjusted hazard ratio 0.85, 95% confidence interval 0.77 to 0.94) and the neonatal mortality rate beyond the first 24 hours (adjusted hazard ratio 0.86, 0.79 to 0.95) were significantly lower in the intervention clusters than in control clusters. The adjusted hazard ratio for neonatal mortality rate was 0.91 (0.80 to 1.03). A significant interaction was found between the place of birth and the effect of the intervention for all mortality outcomes except post-neonatal mortality rate. The neonatal mortality rate was significantly lower in the intervention clusters in the subgroup born at home (adjusted hazard ratio 0.80, 0.68 to 0.93) but not in the subgroup born in a health facility (1.06, 0.91 to 1.23) (P value for interaction = 0.001). Optimal newborn care practices were significantly more common in the intervention clusters.

Conclusions: Implementation of the IMNCI resulted in substantial improvement in infant survival and in neonatal survival in those born at home. The IMNCI should be a part of India's strategy to achieve the millennium development goal on child survival.

Trial registration: Clinical trials NCT00474981; ICMR Clinical Trial Registry CTRI/2009/091/000715.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

None
Trial profile. All recruited live births whose vital status was known at 29 days of age were included in analysis
See this image and copyright information in PMC

Comment in

References

    1. United Nations Children’s Fund. Levels and trends in child mortality: report 2010. Estimates developed by the UN Inter-Agency Group for Child Mortality Estimation. Unicef, 2010.
    1. Darmstadt GL, Bhutta ZA, Cousens SN, Adam T, de Bernis L, Walker N. Evidence-based, cost-effective interventions that matter: how many newborns can we save and at what cost? Lancet 2005;365:977-88. - PubMed
    1. World Health Organization. IMCI adaptation guide, version 5. WHO, 1998.
    1. World Health Organization. Integrated management of neonatal and childhood illnesses. WHO, 2003.
    1. Bang AT, Bang RA, Baitule SB, Reddy H, Deshmukh MD. Effect of home-based neonatal care and management of sepsis on neonatal mortality: field trial in rural India. Lancet 1999;354:1955-61. - PubMed

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