London School of Hygiene & Tropical Medicine

Caption: A Community health worker during a home visit to a mother of a newborn in the Peruvian Amazon. Credit: Mamás del Río

A community-based intervention focused on behaviour-change is effective at improving Essential Newborn Care (ENC) practices in home births and achieves changes sustained over time, according to a new study published in The Lancet Regional Health - Americas.

Researchers from the London School of Hygiene & Tropical Medicine (LSHTM), Stefan Reinders, Carine Ronsmans, Melissa Neuman, and Isabelle Lange, in collaboration with researchers from  Universidad Peruana Cayetano Heredia in Peru, Magaly Blas, Angela Alva and Luis Huicho, have shown that a community-based approach was effective at improving practices in home births in remote and underserved communities in the Peruvian Amazon and provide, for the first time, rigorous evidence on the implementation and impact of a community-based intervention on maternal-neonatal health outcomes in Peru. 

Researchers conducted a before-and-after evaluation using three repeated censuses to measure outcomes in pregnant women and mothers of newborns over a three-year period after implementation of a community-based intervention with supportive facility training.   

Community-based intervention components covered tablet-enhanced home visits by Community health workers to pregnant women and mothers of newborns to educate them about ENC practices, provide clean birth kits and encourage visits to health facilities. In addition, Traditional birth attendants were trained in newborn care practices.

ENC practices are recommended by the World Health Organization for every newborn born in any setting. These practices include hygienic cord care, thermal care and optimal breastfeeding practices, such as early breastfeeding.

The study found consistent improvements in seven out of nine ENC practices for home births, with the largest differences seen in immediate skin-to-skin contact, colostrum feeding and clean cord care.

Stefan Reinders, PhD candidate at LSHTM, member of MARCH and lead author, said: “Our findings show that community-based approaches can be extremely valuable in remote settings with difficult access to high-quality facility care and should be given more consideration in Peru’s national maternal-neonatal health strategy.”

Changes in ENC practices were also measured among health facility births. Smaller improvements were seen in these settings with only three ENC indicators improving, while small but meaningful increases in facility births and newborn check-ups were observed.

Observed changes are especially remarkable given the context of the COVID-19 pandemic and an unprecedented lockdown. While many health facilities suspended routine services, activity of Community health workers largely continued, reinforcing the importance of community-based approaches as an integral part of the health system.

This study is part of the evaluation of the Mamás del Río programme, a community-based intervention that aims to improve maternal and neonatal health by empowering communities in the remote Peruvian Amazon. Large regional health inequalities still persist in Peru and neonatal mortality remains high in the Amazon – one of the poorest, hardest-to-reach, and most underserved regions in Peru.

A previous study by the same group identified large coverage gaps in newborn care in remote indigenous communities with difficult access to high-quality facility care. A further evaluation as part of this study will examine mechanisms of change to confirm these findings and understand the potential for this intervention to be used in other settings.

The research was funded by the Peruvian National Council of Science and Technology and Grand Challenges Canada.