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 2018 - 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.


Overall Project Outcomes and Activities:  

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

The project completed all the tasks written in the project proposal. 114 Health Center staff (HC staff) and 505 Village Health Support Group (VHSG) were trained to provide education/counseling to pregnant women on newborn care. Educational materials (two types of flip-charts, and four types of short video) were developed for use during training of Health Center staff and VHSG. These materials will continue to be used by trainers and we will 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, improve knowledge on hygiene and newborn danger signs by both HC and VHSG. VHSG in the intervention group conducted more home visits than their peers in the control group (through the existing data, we will need to look into the quality of the visits and continue to share the findings). Mothers in the intervention group received health messages from VHSG more than their peers in the control group, but the intervention alone does not change the intended behaviors among the mothers. We found that other factors such as availability of the infrastructure at the household, motorbike/transportation means contribute to the practices of the positive behaviors including prompt referral of sick newborn. Knowledge and attitude will have little impact on the practices unless there are other enabling factors. This could be the 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.


Health Cycle 1 Recipients