Newborn Infection Control and Care Initiative for Health Facilities to Accelerate Reduction of Neonatal Mortality (NICCI)

Principal Investigator: Chivorn Var, National Institute of Public Health (NIPH), Cambodia
NIH-Supported Collaborator: Robert Oberhelman, Tulane School of Public Health and Tropical Medicine
Title of NIH Award: Inter American Training for Innovations in Emerging Infectious Diseases
Project Dates: October 2014 - March 2018

Project Overview:

Newborn mortality continues to be unacceptably high in Cambodia, despite reductions in maternal and under five year old mortality. Evidence exists that a large proportion of newborn mortality globally and in Cambodia is attributable to infections and sepsis and must be addressed. A surge in the number of births at Health Centers unprepared for increased caseloads has likely contributed to substandard hygiene practices and referral. The goal of the project is to implement and evaluate a linked intervention to reduce newborn mortality and morbidity by addressing infection control in the perinatal period, improving recognition of newborn illness, and facilitating prompt referral to appropriate care. The project has two objectives: 1) to improve infection control behavior by staff in selected Health Centers and train health workers in infection control messages to be delivered to pregnant and newly delivered women; 2) to improve referral of sick newborns by Village Health Support Group (VHSG) volunteers and HC staff through: a) increased recognition of danger signs, b) shorter time between recognition of danger signs and care seeking at an appropriate health facility; and 3) to describe the causes of sepsis among infants with possible sepsis from a subset of health center catchment areas. The study will use an experimental design to evaluate a package intervention for the reduction of newborn mortality. The study will incorporate mixed methods including: formative (qualitative) research, a stepped wedge cluster randomized intervention trial and process evaluation. It is anticipated that the results of this study will provide data for policy level actions on newborn survival in Cambodia and in other settings with similar health outcomes. The study may contribute to the potential scale up of a linked model of community-facility care for newborns.


Final Summary of Project Activities

Principal Investigator and Project Coordinator observed project staff interviewing new delivery mothers in Tropaing Snor & Prey Changreak villages.

This project completed all proposed activities. 114 Health Center staff (HC staff) and 505 Village Health Support Group (VHSG) members were trained to provide education/counseling to pregnant women on newborn care. Educational materials (two types of flip-charts and four types of short videos) were developed for use during training of Health Center staff and VHSGs. These materials will continue to be used by trainers as they continue to disseminate the materials for wider use.

The results from the study indicated positive impacts on improving infection control behavior by the HC staff, as well as improved knowledge on hygiene and newborn danger signs by both HC and VHSGs. VHSGs in the intervention group conducted more home visits than their peers in the control group (through the existing data, the team still needs to look into the quality of the visits and continue to share the findings). Mothers in the intervention group received health messages from VHSGs more than their peers in the control group, but the intervention alone does not change the intended behaviors among the mothers. The team found that other factors such as availability of infrastructure at the household level and motorbike/transportation means contribute to the practices of the positive behaviors including prompt referral of sick newborns. Knowledge and attitude will have little impact on the practices unless there are other enabling factors. This is an important point to share with relevant policy makers/implementer on a comprehensive approach (not only focus on knowledge and attitude, but also enabling factors) toward infection control, hygiene, and referral of newborn care.

Publications

Alessandra N. Bazzano, Chivorn Var, Francoise Grossman, Richard A. Oberhelman, Use of Camphor and Essential Oil Balms for Infants in Cambodia, Journal of Tropical Pediatrics, Volume 63, Issue 1, February 2017, Pages 65–69, https://doi.org/10.1093/tropej/fmw013

Bazzano AN, Taub L, Oberhelman RA, Var C. Newborn Care in the Home and Health Facility: Formative Findings for Intervention Research in Cambodia. Healthcare. 2016; 4(4):94. https://doi.org/10.3390/healthcare4040094

Bazzano A, Oberhelman R, Storck Potts K, Taub L, Var C. What health service support do families need for optimal breastfeeding? An in-depth exploration of young infant feeding practices in Cambodia. Int J Womens Health. 2015;7:249-257. https://doi.org/10.2147/IJWH.S76343

Bazzano AN, Oberhelman RA, Potts KS, Gordon A, Var C. Environmental Factors and WASH Practices in the Perinatal Period in Cambodia: Implications for Newborn Health. International Journal of Environmental Research and Public Health. 2015; 12(3):2392-2410. https://doi.org/10.3390/ijerph120302392

Var, C., Bazzano, A.N., Srivastav, S.K. et al. Newborn Infection Control and Care Initiative for health facilities to accelerate reduction of newborn mortality (NICCI): study protocol for a randomized controlled trial. Trials 16, 257 (2015). https://doi.org/10.1186/s13063-015-0771-5

Health Cycle 1 Recipients