Despite the global decline, neonatal mortality rates (NMR) remain high in India. Family members are often responsible for the postpartum care of neonates and mothers. Yet, low health literacy and varied beliefs can lead to poor health outcomes. Postpartum education for family caregivers may improve the adoption of evidence-based neonatal care and health outcomes. The Care Companion Program (CCP) is a hospital-based, pre-discharge health training session where nurses teach key healthy behaviors to mothers and family members, including skills and an opportunity to practice them in the hospital. We conducted a quasi-experimental study to assess the effect of the CCP sessions on mortality outcomes among families seeking care in 28 public tertiary facilities across 4 Indian states. Neonatal mortality outcomes were reported post-discharge, collected via phone surveys at four weeks postpartum, between October 2018 to February 2020. Risk ratios (RR), adjusting for hospital-level clustering, were calculated by comparing mortality rates before and after CCP implementation. A total of 46,428 families participated in the pre-intervention group and 87,305 in the post-intervention group; 76% of families completed the phone survey. Among the 33,599 newborns born before the CCP implementation, there were 1386 deaths (NMR: 41.3 deaths per 1000 live births). After the intervention began, there were 2021 deaths out of 60,078 newborns born (crude NMR: 33.6 deaths per 1000 live births, RR=0.82, 95% CI: 0.76, 0.87; cluster-adjusted RR=0.82, 95% CI: 0.71, 0.94). There may be a substantial benefit to family-centered education in the early postnatal period to reduce neonatal mortality.Despite the recent global decline, neonatal mortality rates (NMR) remain high in India. Family members are often responsible for the postpartum care of newborns neonates and mothers. Yet, low health literacy and varied beliefs can lead to poor neonatal health outcomes. Postpartum education for family caregivers can improve the adoption of evidence-based newborn neonatal care and health outcomes. The Care Companion Program (CCP) is a hospital-based, pre-discharge health training session where nurses teach key healthy behaviors and help to mothers and family members, including learning skills and an opportunity to practice them in the hospital. Here, we assessed the impact of CCP on NMR. We conducted a quasi-experimental study to assess the effect of the CCP sessions on mortality outcomes among families seeking care in 28 public tertiary facilities, across 4 Indian states. Neonatal mortality outcomes were reported post-discharge, collected via phone surveys at four weeks of age of the baby between October 2018 to February 2020. Risk ratios (RR), adjusting for hospital-level clustering, were calculated by comparing mortality rates before and after CCP implementation. A total of 46,428 families participated in the pre-intervention group and 87,305 in the post-intervention group; 76% of families participated completed the phone survey. Among the 33,599 newborns born before the CCP implementation, there were 1386 deaths (NMR: 41.3 deaths per 1000 live births). After the intervention began, there were 2021 deaths out of 60,078 newborns born (crude NMR: 33.6 deaths per 1000 live births, RR=0.82, 95% CI: 0.76, 0.87; RR=0.82, 95% CI: 0.76, 0.87; hospital cluster-adjusted NMR:41.3deaths per 1000 live births, cluster-adjusted RR=0.821, 95% CI: 0.71, 0.943 ). The crude NMR was 33.64 deaths per 1000 live births (RR=0.82, 95% CI: 0.76, 0.87). After accounting for hospital clustering, the NMR was 41.3 (adjusted RR=0.81, 95% CI: 0.71, 0.93). There may be a substantial benefit to family-centered education in the early postnatal period to reduce neonatal mortality.
Trained investigators collected contact details of the mothers in the hospital, after delivering the baby, and just before discharge. Among eligible participants, consent for the study was asked for in the hospital and reconfirmed at the time of the survey call. At the end of the neonatal period (i.e. 4 weeks post-discharge), the study staff called the consenting and eligible mothers to learn about the vital status and neonatal care behaviors. At the beginning of the follow-up phone call, the vital status of the mother and newborn was collected. Maternal deaths during pregnancy, during hospital delivery before discharge, abortions, home deliveries, or those who died after 28 days and before 42 days are not included