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Objective To evaluate and compare the cost-effectiveness of two strategies for neonatal care in Sylhet division, Bangladesh. Methods In a cluster-randomized controlled trial, two strategies for neonatal care--known as home care and community care--were compared with existing services. For each study arm, economic costs were estimated from a societal perspective, inclusive of programme costs, provider costs and household out-of-pocket payments on care-seeking. Neonatal mortality in each study arm was determined through household surveys. The incremental cost-effectiveness of each strategy- compared with that of the pre-existing levels of maternal and neonatal care--was then estimated. The levels of uncertainty in our estimates were quantified through probabilistic sensitivity analysis. Findings The incremental programme costs of implementing the home-care package were 2939 (95% confidence interval, Cl: 1833-7616) United States dollars (US$) per neonatal death averted and US$103.49 (95% CI: 64.72-265.93) per disability-adjusted life year (DALY) averted. The corresponding total societal costs were US$ 2971 (95% CI: 1844-7628) and US$104.62 (95% CI: 65.15-266.60), respectively. The home-care package was cost-effective--with 95% certainty--if healthy life years were valued above US$ 214 per DALY averted. In contrast, implementation of the community-care strategy led to no reduction in neonatal mortality and did not appear to be cost-effective. Conclusion The home-care package represents a highly cost-effective intervention strategy that should be considered for replication and scale-up in Bangladesh and similar settings elsewhere. Objectif Evaluer et comparer le rapport coOt-ethcacite de deux strategies pour les soins neonataux a Sylhet, Bangladesh. Methodes Dans un essai controle randomise par grappes, deux strategies pour les soins neonataux--connues sous le nom de soins a domicile et de soins communautaires- ont ete comparees aux services existants. Pour chaque branche de l'etude, les couts economiques ont ete estimes d'un point de vue societal, et comprennent les couts du programme, les couts des fournisseurs et les paiements directs des menages pour les soins. La mortalite neonatale dans chaque branche de letude a ete determinee au moyen d'enquetes sur les menages. Le rapport cout-efficacite de chaque strategie- par rapport au niveau des services de soins de sante maternelle et neonatale pre-existants--a ensuite ete estime. Les niveaux d'incertitude dans nos estimations ont ete quantifies par analyse de sensibilite probabiliste. Resultats Les couts marginaux de programme de mise en place de l'ensemble des soins a domicile s'elevaient a 2939 dollars US (intervalle de confiance a 95%, IC: 1833-7616) par deces neonatal evite et a 103,49 $ (IC a 95%: 64,72-265,93) par annee de vie ajustee en fonction de l'incapacite. Le total des couts societaux correspondants etaient de 2971 $ (IC a 9.5%: 1844-7628) et de 104,62 $ (IC a 95%: 65,15-266,60), respectivement. Le forfait de soins a domicile est rentable--a 95%- si les annees de vie en bonne sante sont evaluees a plus de 214 $ par annee de vie ajustee en fonction de l'incapacite. En revanche, la mise en ceuvre de la strategie communautaire de sante n'a conduit a aucune reduction de la mortalite neonatale et ne semble pas etre rentable. Conclusion Le forfait de soins a domicile est une strategie d'intervention extremement rentable dont la mise en place doit etre envisagee a l'echelle du Bangladesh et partout ailleurs dans des contextes similaires. Objetivo Evaluar y comparar la rentabiliad de dos estrategias de atencion neonatal en la division Sylhet, Bangladesh. Metodos Se compararon dos estrategias de atencion neonatal, conocidas como atencion domiciliaria y atencion comunitaria, con los servicios existentes en un ensayo controlado aleatorio por grupos. Para cada grupo de estudio se estimaron los costes economicos a partir de una perspectiva social, que incluia los costes del programa, los costes de los proveedores y los pagos familiares para recibir atencion sanitaria. La mortalidad neonatal en cada grupo de estudio se determino mediante encuestas familiares. Posteriormente, se estimo la rentabilidad creciente de cada estrategia en comparacion con la de los niveles preexistentes de atencion materna y neonatal. Los niveles de incertidumbre de nuestras estimaciones se cuantificaron mediante un analisis de sensibilidad probabilistico. Resultados Los costes crecientes de los programas para la aplicacion de los paquetes de atencion domiciliaria fueron de 2939 (intervalo de confianza del 95%, IC: 1833-7616) dolares de los Estados Unidos de America (US$) por muerte neonatal evitada y US$103,49 (IC del 95%: 64,72-265,93) por ano de vida ajustado por discapacidad (AVAD) evitado. Los correspondientes costes sociales totales fueron de US$ 2971 (IC del 95%: 1844-7628) y US$104,62 (IC del 95%: 65,15-266,60), respectivamente. El paquete de atencion domiciliaria fue rentable (con 95% de certeza) cuando los anos de vida saludable se evaluaban por encima de US$ 214 por AVAD evitado. Por el contrario, la aplicacion de la estrategia de atencion comunitaria no condujo a una reduccion de la mortalidad neonatal y no parece ser rentable. Conclusion El paquete de atencion domiciliaria representa una estrategia de intervencion con una rentabilidad alta cuya replicacion y la ampliacion deberia considerarse tanto en Bangladesh como en otros entornos similares., Introduction Globally, an estimated 7.6 million children aged younger than 5 years--including 3.1 million infants less than 28 days old--died in 2010. (1) Of the deaths that occur each year [...]

Abstract Background Well-trained and highly motivated community health workers (CHWs) are critical for delivery of many community-based newborn care interventions. High rates of CHW attrition undermine programme effectiveness and potential for implementation at scale. We investigated reasons for high rates of CHW attrition in Sylhet District in north-eastern Bangladesh. Methods Sixty-nine semi-structured questionnaires were administered to CHWs currently working with the project, as well as to those who had left. Process documentation was also carried out to identify project strengths and weaknesses, which included in-depth interviews, focus group discussions, review of project records (i.e. recruitment and resignation), and informal discussion with key project personnel. Results Motivation for becoming a CHW appeared to stem primarily from the desire for self-development, to improve community health, and for utilization of free time. The most common factors cited for continuing as a CHW were financial incentive, feeling needed by the community, and the value of the CHW position in securing future career advancement. Factors contributing to attrition included heavy workload, night visits, working outside of one's home area, familial opposition and dissatisfaction with pay. Conclusions The framework presented illustrates the decision making process women go through when deciding to become, or continue as, a CHW. Factors such as job satisfaction, community valuation of CHW work, and fulfilment of pre-hire expectations all need to be addressed systematically by programs to reduce rates of CHW attrition.

Abstract Background The World Health Organization recommends dry cord care for newborns but this recommendation may not be optimal in low resource settings where most births take place in an unclean environment and infections account for up to half of neonatal deaths. A previous trial in Nepal indicated that umbilical cord cleansing with 4.0% chlorhexidine could substantially reduce mortality and omphalitis risk, but policy changes await additional community-based data. Methods The Projahnmo Chlorhexidine study was a three-year, cluster-randomized, community-based trial to assess the impact of three cord care regimens on neonatal mortality and omphalitis. Women were recruited mid-pregnancy, received a basic package of maternal and neonatal health promotion messages, and were followed to pregnancy outcome. Newborns were visited at home by local village-based workers whose areas were randomized to either 1) single- or 2) 7-day cord cleansing with 4.0% chlorhexidine, or 3) promotion of dry cord care as recommended by WHO. All mothers received basic messages regarding hand-washing, clean cord cutting, and avoidance of harmful home-base applications to the cord. Death within 28 days and omphalitis were the primary outcomes; these were monitored directly through home visits by community health workers on days 1, 3, 6, 9, 15, and 28 after birth. Discussion Due to report in early 2010, the Projahnmo Chlorhexidine Study examines the impact of multiple or single chlorhexidine cleansing of the cord on neonatal mortality and omphalitis among newborns of rural Sylhet District, Bangladesh. The results of this trial will be interpreted in conjunction with a similarly designed trial previously conducted in Nepal, and will have implications for policy guidelines for optimal cord care of newborns in low resource settings in Asia. Trial Registration ClinicalTrials.gov (NCT00434408)

Background: Studies have revealed associations between preceding short and long birth-to-birth or birth-to-pregnancy intervals and poor pregnancy outcomes. Most of these studies, however, have examined the effect of intervals that began with live births. Using data from Bangladesh, we examined the effect of inter-outcome intervals (IOI) starting with a non-live birth or neonatal death, on outcomes in the next pregnancy. Pregnancy spacing behaviors in rural northeast Bangladesh have changed little since 2004.Methods: We analyzed pregnancy histories for married women aged 15-49 years who had outcomes between 2000 and 2006 in Sylhet, Bangladesh. We examined the effects of the preceding outcome and the IOI length on the risk of stillbirth, neonatal death and spontaneous abortion using multinomial logistic regression models.Results: Data included 64,897 pregnancy outcomes from 33,495 mothers. Inter-outcome intervals of 27-50 months and live births were baseline comparators. Stillbirths followed by IOI's <=6 months, 7-14 months or overall <=14 months had increased risks for spontaneous abortion with adjusted relative risk ratios (aRRR) and 95% confidence intervals = 29.6 (8.09, 108.26), 1.84 (0.84, 4.02) and 2.53 (1.19, 5.36), respectively. Stillbirths followed by IOIs 7-14 months had aRRR 2.00 (1.39, 2.88) for stillbirths. Neonatal deaths followed by IOIs <=6 months had aRRR 28.2 (8.59, 92.63) for spontaneous abortion. Neonatal deaths followed by IOIs 7-14 and 15-26 months had aRRRs 3.08 (1.82, 5.22) and 2.32 (1.38, 3.91), respectively, for stillbirths; and aRRRs 2.81 (2.06, 3.84) and 1.70 (1.24, 3.84), respectively, for neonatal deaths. Spontaneous abortions followed by IOIs <=6 months and 7-14 months had, respectively, aRRRs 23.21 (10.34, 52.13) and 1.80 (0.98, 3.33) for spontaneous abortion.Conclusion: In rural northeast Bangladesh, short inter-outcome intervals after stillbirth, neonatal death and spontaneous abortion were associated with a high risk of a similar outcome in the next pregnancy. These findings are aligned with other studies from Bangladesh. Two studies from similar settings have found benefits of waiting six months before conceiving again, suggesting that incorporating this advice into programs should be considered. Further research is warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

The article presents a study which assesses the effectiveness of single or daily umbilical cord cleaning regimens with the promotion of dry cord care in neonatal mortality prevention. It states that the study was a community-based, parallel cluster-randomised trial in Sylhet, Bangladesh. It concludes that though umbilical cord cleaning with Chlorhexidine can save lives, determining the best treatment frequency requires further studies.

Background: Pneumonia remains the leading cause of mortality in under-five children outside the neonatal period. Progress has slowed down in the last decade, necessitating increased efforts to scale up effective pneumonia interventions., Methods: We used the Lives Saved Tool (LiST), a modelling software for child mortality in low- and middle-income settings, to prospectively analyse the potential impact of upscaling pneumonia interventions in Bangladesh, Chad, and Ethiopia from 2023 to 2030. We included Haemophilus influenzae type B (Hib) vaccination, pneumococcal conjugate vaccine (PCV), oral antibiotics, pulse oximetry, and oxygen as pneumonia interventions in our analysis. Outcomes of interest were the number of pneumonia deaths averted, the proportion of deaths averted by intervention, and changes in the under-five mortality rate., Findings: We found that 19 775 lives of children under-five could be saved in Bangladesh, 76 470 in Chad, and 97 343 in Ethiopia by scaling intervention coverages to ≥90% by 2030. Our estimated reductions in pneumonia deaths among children under five range from 44.61% to 57.91% in the respective countries. Increased coverage of oral antibiotics, pulse oximetry, and oxygen show similar effects in all three countries, averting between 18.80% and 23.65% of expected pneumonia deaths. Scaling-up PCV has a prominent effect, especially in Chad, where it could avert 14.04% of expected pneumonia deaths. Under-five mortality could be reduced by 1.42 per 1000 live births in Bangladesh, 22.52 per 1000 live births in Chad, and 5.48 per 1000 live births in Ethiopia., Conclusions: This analysis shows the high impact of upscaling pneumonia interventions. The lack of data regarding coverage indicators is a barrier for further research, policy, and implementation, all requiring increased attention., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose the following activities and/or relationships: FL is employed by CHAI and implementing oxygen strengthening programmes across low-resource settings. RS and SR (Rashed and Shohel) have been working for Fighting Against Childhood Pneumonia projects in Save the Children., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)