Reduced Incidence of Maternal Health Conditions Associated with the Home-Based Newborn Care Intervention Package in Rural Gadchiroli, India: A 13 Years Before – After Comparison

Objective: To assess the association of home-based neonatal care interventions with the incidence of various maternal health conditions observed over 13 years in the intervention area of the field-trial of home-based neonatal care. Methods: This was a retrospective analysis of a program implemented in thirty-nine villages in Gadchiroli, India. The home-based newborn care interventions were incrementally introduced during the field trial (1995 – 1998) and subsequently continued as a service program till 2008. Pregnant women were recruited over the thirteen year period (1995–2008) and followed up from the seventh month of pregnancy to 28 days postpartum by trained female community health workers who made antenatal, natal and post-natal home visits (total 10), provided health education to mothers for behavior change, managed normal and sick neonates as well as encouraged seeking medical care when necessary. They recorded maternal signs and symptoms; verified by a supervisory physician. Based on these, a computer algorithm diagnosed 20 types of maternal health conditions. The incidence of the conditions in the first year (1995-96) was compared with the last two years (2006 - 2008) of intervention. Result: The mean coverage of home-based newborn care, assessed on eight indicators, increased from 48.5% in 1995 – 96 to 87.1% in 2006 – 08. Proportion of women with any maternal health conditions in pregnancy reduced from 40.67% to 22.47% (by 44.76%, p < 0.001), in labor reduced from 12.31% to 6.82% (by 44.59%, p <0.001) and during the post-partum from 43.91% to 9.74% (by 77.82%, p <0.001). Mean number of maternal conditions per 100 women reduced from 140 to 44 (by 69%, p < 0.001). Need for emergency obstetric care reduced from 5.83% to 1.23% (by 78.83%, p < 0.001). Proportion of condition free mothers increased from 32.9 % to 64.6 %. Conclusion: Home based neonatal care interventions were associated with significant reduction in the incidence of maternal health conditions. Developing home-based maternal care in combination with neonatal care may considerably improve maternal health.