Evaluation of the Impact of the Integrated Management of Neonatal and Childhood Illness Strategy on Neonatal and Infant Mortality

Funding: UNICEF, WHO and RCN (GlobVac)
Coordinators: Nita Bhandari & Halvor Sommerfelt
Period: 01.04.2008 - 31.12.2011
Project page at RCN
India: The Norwegian Institute of Public Health part of research project

This is a cluster-randomized trial in Haryana, North India. Eighteen geographical areas served by Primary Health Centres (PHCs) (average population 30,000) were randomized to intervention or comparison areas.

The IMNCI intervention includes three main components:
a) improvements in the case management skills of health staff
b) improvements in the overall health system to support its performance
c) improvements in family and community health care practices; concretely:
-prevention and management of hypothermia -early initiation of breastfeeding and exclusive breastfeeding
-community-based care of low birth weight infants
-improved care-seeking for neonatal infections

The primary outcome measure is neonatal mortality. The study will also collect information on cause-specific neonatal mortality, ascertained using a standardized previously validated verbal autopsy instrument administered by trained, skilled health workers. All the other outcomes (including Infant mortality; Initiation of breastfeeding within 1 hour of birth; Exclusive breastfeeding at 4 weeks of age; Proportion of neonates identified to be sick by caregivers who sought care) are secondary outcomes.

The effectiveness of this comprehensive intervention will be measured by comparing the primary and secondary outcome measures in the intervention and comparison clusters, controlling for any baseline differences such as the predefined outcomes and/or socioeconomic status and demography.

The project will serve as a guide to the Government of India of how to best implement the IMNCI strategy and measure its impact. It may also yield information critical to the implementation of the National (Indian) Rural Health Mission (NRHM) and to Norway's participation (NIPI) in RHM and to other large national and global programs aimed at enhancing child survival.