CHWs (53) CHWs and newborn care

8 November, 2019

Dear HIFA and CHIFA (child health) members

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The new print issue of The Lancet has an important paper with 'important public health implications. Our findings together with those from facility-initiated kangaroo mother care trials provide conclusive evidence that kangaroo mother care, irrespective of the setting where it is initiated, has major benefits for the survival and growth of babies and infants with low birthweight. This finding implies that kangaroo mother care should be initiated for stable babies with low birthweight as soon as possible and should be given right through the neonatal period for as long as possible every day, as feasible'.

'The intervention delivery workers had 10–12 years of school education, but no previous training in health care. Their educational background was similar to community health workers in India. Their supervisors were college graduates with no previous training in health care, similar to Accredited Social Health Activist (ASHA) supervisors (ie, government community health workers).'

Citation, summary and a comment from me below. Full text (free after one-time free registration) here:

CITATION: Effect of community-initiated kangaroo mother care on survival of infants with low birthweight: a randomised controlled trial

Sarmila Mazumder et al.

Published: October 04, 2019



Background: Coverage of kangaroo mother care remains very low despite WHO recommendations for its use for babies with low birthweight in health facilities for over a decade. Initiating kangaroo mother care at the community level is a promising strategy to increase coverage. However, knowledge of the efficacy of community-initiated kangaroo mother care is still lacking. We aimed to assess the effect of community-initiated kangaroo mother care provided to babies weighing 1500–2250 g on neonatal and infant survival.

Methods: In this randomised controlled, superiority trial, undertaken in Haryana, India, we enrolled babies weighing 1500–2250 g at home within 72 h of birth, if not already initiated in kangaroo mother care, irrespective of place of birth (ie, home or health facility) and who were stable and feeding. The first eligible infants in households were randomly assigned (1:1) to the intervention (community-initiated kangaroo mother care) or control group...

Findings: Between July 30, 2015, and Oct 31, 2018, 8402 babies were enrolled, of whom 4480 were assigned to the intervention group and 3922 to the control group. Most births (6837 [81·4%]) occurred at a health facility, 36·2% (n=3045) had initiated breastfeeding within 1 h of birth, and infants were enrolled at an average of about 30 h (SD 17) of age. Vital status was known for 4470 infants in the intervention group and 3914 in the control group at age 28 days, and for 3653 in the intervention group and 3331 in the control group at age 180 days. Between enrolment and 28 days, 73 infants died in 4423 periods of 28 days in the intervention group and 90 deaths in 3859 periods of 28 days in the control group (hazard ratio [HR] 0·70, 95% CI 0·51–0·96; p=0·027). Between enrolment and 180 days, 158 infants died in 3965 periods of 180 days in the intervention group and 184 infants died in 3514 periods of 180 days in the control group (HR 0·75, 0·60–0·93; p=0·010). The risk ratios for death were almost the same as the HRs (28-day mortality 0·71, 95% CI 0·52– 0·97; p=0·032; 180-day mortality 0·76, 0·60–0·95; p=0·017).

Interpretation: Community-initiated kangaroo mother care substantially improves newborn baby and infant survival. In low-income and middle-income countries, incorporation of kangaroo mother care for all infants with low birthweight, irrespective of place of birth, could substantially reduce neonatal and infant mortality.

Comment (Neil PW): This is yet another area where CHWs can be trained to deliver specific tasks. In our discussion on CHWs, we tend to talk about them in generalities and forget that (a) the number of potential tasks that could be undertaken by CHWs is far more than could ever be expected of one cadre, and (b) CHWs are in fact a highly heterogenous group with diverse training needs. Many (an increasing percentage?) CHWs could be described as 'specialist CHWs', like the ones engaged in the above study. I am not sure we (or the CHW Guideline) have got to grips with this diversity and how to manage it. The Guideline notes that there can be no such thing as a universal curriculum, which had previously (and perhaps still is?) been promoted by many. Perhaps there is a case for a 'basic CHW training' followed by 'specialist CHW training'?

Best wishes, Neil

Coordinator, HIFA Project on Library and Information Services

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: