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Ghana Newborn Home Visits Neonatal Mortality Trial (Newhints)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00623337
Recruitment Status : Completed
First Posted : February 26, 2008
Last Update Posted : August 24, 2017
Kintampo Health Research Centre, Ghana
Institute of Child Health
Information provided by (Responsible Party):
London School of Hygiene and Tropical Medicine

Tracking Information
First Submitted Date  ICMJE February 15, 2008
First Posted Date  ICMJE February 26, 2008
Last Update Posted Date August 24, 2017
Study Start Date  ICMJE January 2009
Actual Primary Completion Date March 2010   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: February 15, 2008)
Neonatal mortality rate [ Time Frame: deaths within 28 days of birth ]
Original Primary Outcome Measures  ICMJE Same as current
Change History
Current Secondary Outcome Measures  ICMJE
 (submitted: February 15, 2008)
% mothers carrying out promoted newborn care practices [ Time Frame: within 28 days of birth ]
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
Descriptive Information
Brief Title  ICMJE Ghana Newborn Home Visits Neonatal Mortality Trial
Official Title  ICMJE Cluster Randomised Trial to Evaluate the Impact of Routine Home Visits to Provide a Package of Essential Newborn Care Interventions in the Third Trimester of Pregnancy and the 1st Week of Life on Neonatal Mortality in Rural Ghana
Brief Summary

Introduction: Just under four million infants die each year before reaching one month of age; neonatal deaths now account for 38% of the 10.8 million deaths among children younger than 5 years of age. Tackling neonatal mortality is essential if the millennium development goal to reduce by 2015 overall child mortality by two-thirds from its levels in 1990 is to be achieved. Postnatal care for mothers and neonates in developing countries, particularly when deliveries occur at home, is either not available or is of poor quality. Trained community workers are considered by many to be pivotal to newborn care in the community, as they can act as catalysts for community actions and also be providers of care.Reductions in neonatal mortality have been slower in Sub-Saharan Africa than in any other region, and no evaluations of the effectiveness and feasibility of home visits in reducing neonatal mortality have been conducted.

Trial aim: To link with the Ghana Health Service to develop a feasible and sustainable intervention to improve newborn care practices and careseeking during pregnancy and childbirth, and to identify and refer very low birth weight and/or sick babies, through routine home-visits by community health workers (CHWs), and by so doing reduce neonatal mortality.

Detailed Description

Study area: The NEWHINTS trial will be conducted in 6 contiguous districts with an area of 12,000km in the central Brong Ahafo Region of rural Ghana. The area is predominantly rural and has a total population of approximately 600,000 persons, with more than 100,000 women of reproductive age. The study area is multi-ethnic and education levels are low. It is served by 4 district hospitals, and a small number of additional government health centres and private facilities. More than 15,000 babies are born within the area each year; the neonatal mortality rate is about 30 per 1000 live births. Over 50% of births occur at home and these home deliveries account for a large proportion of all neonatal deaths. A potential cadre of CHWs, who are currently working in the region and whose capacity could be expanded to include home visits, are Community Based Surveillance Volunteers (CBSVs); CBSVs currently assist the DHMTs with the registration of births, disease detection and community mobilization.

Intervention: The intervention is being developed by a collaborative group from Kintampo Health Research Centre, the District Health Management Teams (DHMTs) of the 6 districts and the London School of Hygiene and Tropical Medicine. It will comprise of:

  1. Training CBSVs to identify pregnant women in the community and to conduct 2 home visits during pregnancy and 3 in the first week of life of the infant on days 1, 3 and 7:

    • to promote birth preparedness and prompt careseeking during pregnancy and childbirth
    • to promote essential perinatal and neonatal care practices
    • to identify and refer very low birth weight or sick babies
    • to give advice on special treatment for low birth weight babies
    • to teach neonatal danger signs and encourage prompt careseeking
    • to promote key child survival interventions for infancy (breastfeeding, bednets, immunisations) CBSVs will provide support through dialogue and problem-solving. Other family members key in decision-making concerning childbirth and newborn care will be invited to take part in the discussions.
  2. Developing a sustainable supervisory and remuneration structure for the CBSVs;
  3. Various intervention support activities inc

    • Sensitisation of health facility staff to intervention messages and approach#
    • Sensitisation of traditional birth attendants (TBAs)
    • Meetings with village leaders to introduce intervention aims and activities
    • Community durbars

Study design: Formative research consisting of in-depth interviews, focus-groups and pilot trials of home visits/improved practices will be conducted to improve the feasibility and optimality of the planned intervention and to design training and intervention support materials. A cluster randomised controlled trial design with 98 health zones as units of randomisation will be used to evaluate the impact on neonatal mortality, careseeking during pregnancy and childbirth and newborn care practices. The intervention will be implemented in half of the zones, chosen at random, and evaluated over an 18 month period. Impact data will come from ongoing 4-weekly surveillance of all women of child-bearing age and their infants including verbal post mortems, conducted as part of the ongoing "ObaapaVitA" Vitamin A and maternal mortality trial. A process evaluation will be conducted over 3-monthly intervals to assess the coverage and quality of the services provided and the response to the services.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 3
Study Design  ICMJE Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Condition  ICMJE Neonatal Mortality
Intervention  ICMJE Behavioral: Home visits
Home visits by community based surveillance volunteers (2 during pregnancy & 3 during 1st week of life) to promote facility delivery, careseeking during pregnancy and childbirth and essential newborn care practices and to identify & refer sick babies
Study Arms  ICMJE
  • Experimental: Newhints
    Home visits
    Intervention: Behavioral: Home visits
  • No Intervention: Control
    Community based surveillance volunteers will continue with current duties eg urging attendance at immunisation clinics and child health weeks
Publications *

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
Recruitment Information
Recruitment Status  ICMJE Completed
Estimated Enrollment  ICMJE
 (submitted: February 17, 2010)
Original Estimated Enrollment  ICMJE
 (submitted: February 15, 2008)
Actual Study Completion Date  ICMJE April 2010
Actual Primary Completion Date March 2010   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  • All live births in trial area

Exclusion Criteria:

  • None
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE up to 12 Months   (Child)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE Ghana
Removed Location Countries  
Administrative Information
NCT Number  ICMJE NCT00623337
Other Study ID Numbers  ICMJE Newhints
WHO: C6-181-512,# 007
SNL: Sub-grant # 251
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product Not Provided
IPD Sharing Statement  ICMJE Not Provided
Current Responsible Party London School of Hygiene and Tropical Medicine
Original Responsible Party Betty Kirkwood, LSHTM
Current Study Sponsor  ICMJE London School of Hygiene and Tropical Medicine
Original Study Sponsor  ICMJE Same as current
Collaborators  ICMJE
  • Kintampo Health Research Centre, Ghana
  • Institute of Child Health
Investigators  ICMJE
Principal Investigator: Betty R Kirkwood London School of Hygiene & Tropical Medicine (LSHTM)
Principal Investigator: Zelee E Hill Institute of Child Health, London
Principal Investigator: Alexander Manu Kintampo Health Research Centre (KHRC)
Principal Investigator: Charlotte Tawiah KHRC
Principal Investigator: Seth Owusu-Agyei KHRC
PRS Account London School of Hygiene and Tropical Medicine
Verification Date February 2010

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP