Background: In Northern Nigeria, infant mortality rates are two to three times higher than
in the southern states, and, in 2008, a partnership program to improve maternal, newborn, and
child health was established to reduce infant and child mortality in three Northern Nigeria states.
The program intervention zones received government-supported health services plus integrated
interventions at primary health care posts and development of community-based service delivery
(CBSD) with a network of community volunteers and community health workers (CHWs), who
focus on educating women about danger signs for themselves and their infants and promoting
appropriate responses to the observation of those danger signs, consistent with the approach
of the World Health Organization Integrated Management of Neonatal and Childhood Illness
strategy. Before going to scale in the rest of the state, it is important to identify the relative
effectiveness of the low-intensity volunteer approach versus the more intensive CBSD approach
with CHWs.
Methods: We conducted stratified cluster sample household surveys at baseline (2009) and
follow-up (2011) to assess changes in newborn and sick child care practices among women
with births in the five prior years (baseline: n = 6,906; follow-up: n = 2,310). The follow-up
respondents were grouped by level of intensity of the CHW interventions in their community,
with “low” including group activities led only by a trained community volunteer and
“high” including the community volunteer activities plus CBSD from a CHW providing
one-on-one advice and assistance. t-tests were used to test for significant differences from
baseline to follow-up, and F-statistics, which adjust for the stratified cluster design, were
used to test for significant differences between the control, low-intensity, and high-intensity
intervention groups at follow-up. These analyses focused on changes in newborn and sick
child care practices.
Results: Anti-tetanus vaccination coverage during pregnancy increased from 69.2% at baseline
to 85.7% at follow-up in the intervention areas. Breastfeeding within 24 hours increased from
42.9% to 59.0% in the intervention areas, and more newborns were checked by health workers
within 48 hours (from 16.8% at baseline to 26.8% at follow-up in the intervention areas).
Newborns were more likely to be checked by trained health personnel, and they received more
comprehensive newborn care. Compared to the control communities, more than twice as
many women in intervention communities knew to watch for specific newborn danger signs.
Compared to the control and low-intensity intervention communities, more mothers in the
high-intensity communities learned about the care of sick children from CHWs, with a corresponding
decline those seeking advice from family or friends or traditional birth attendants.
Significantly fewer mothers did nothing when their child was sick. High-intensity intervention communities experienced the most decline. Those who did nothing for children with fever or cough declined from 35% to 30%, and with
diarrhea from 40% to 31%. Use of medications, both traditional and modern, increased from baseline to follow-up, with no differentiation
in use by intervention area.
Conclusion: The community-based approach to promoting improved newborn and sick child care through community volunteers and
CHWs resulted in improved newborn and sick child care. The low-intensity approach with community volunteers appears to have been
as effective as the higher-intensity CBSD approach with CHWs for several of the key newborn and sick child care indicators, particularly
in the provision of appropriate home care for children with fever or cough.