724 - Community Based Low-Birth Weight Surveillance– A 10-Year Evaluation of Program Effectiveness in Rural India

Publication Number: 724.4557

Allison Judkins, University of Utah School of Medicine, Salt Lake City, UT, United States; Bernhard Fassl, Bernhard Fassl NEOMED, ROOTSTOWN, OH, United States

Background: Forty to forty five percent of all child deaths under the age of five occur in the neonatal period (0-28 days). Low-birth weight (LBW), (birth weight < 2.5 kg) regardless of gestational age, is the most prevalent underlying risk factor in all-cause mortality. Greater than 90% of LBW infants are born in low- and middle-income countries, of which 28% are born in South Asia. India’s 2014 Ministry of Health and Family Welfare report showed that 30% of live births are LBW.

Objective: To assess the effectiveness of a Community-Based LBW Surveillance Program on neonatal mortality in rural India.

Design/Methods: The study took place in Sinor, Gujarat, India at Mota Fofalia Community Health Center (MFCHC) which serves 42 surrounding villages and a total population of approximately 80,000 people. MFCHC is operated through a public-private-partnership between government of Gujarat and the Shakti Krupa Charitable Trust (SKCT).
Study design
This prospective cohort study was designed and implemented by SKCT in collaboration with the University of Utah to improve outcomes in Sinor. Institutional Review Board approval was obtained from the University of Utah. All LBW infants born at MFCHC included in the study. Data for non-intervention, baseline infants, were collected on a random sample of every fifth LBW infant born at MFCHC between January 2012 and May 2014. These infants were followed up at home between March-July 2014 and assessed for age, weight and mortality.
The hospital-to-home intevention program began in August 2014. A local Gujarati field team manager obtained patient data from the hospital birth registry:, birth dates, birth weight, sex, parental demographics and home address. After discharge, the field manager provided home visits based and assessed infants using a standardized risk assessment tool for evaluation: current weight gain/loss, feeding practices, care environment, socio-economic parameters and danger signs. He worked in conjunction with government community health workers (ASHA) and trained additional team members.

Results: A total of 2907 LBW infants were part of the SKCT health surveillance initiative. Baseline mortality was 13% at 6 months of age and was reduced to 3% at 6 months of age by 2015. Further reductions of mortality and sustainment of results were achieved over a 10 year period.

Conclusion(s): This successful community-bsed surveillance program has reduced neonatal mortality and sustained this improvement since program inception. Further investigation in the longer term childhood and nutritional outcomes is required.

6 month LBW mortality rate
6 month mortality rate of all neonates born at CAPH hospital between 2014 and 2022.