Improving newborn health with family-centered, early postnatal care: a quasi-experimental study

28 Despite the recent decline, neonatal mortality rates (NMR) remain high in India. Family members are 29 often responsible for the postpartum care of newborns and mothers. Yet, low health literacy and varied 30 beliefs can lead to poor neonatal health outcomes. Postpartum education for family caregivers can 31 improve the adoption of evidence-based newborn care and health outcomes. The Care Companion 32 Program (CCP) is a hospital-based, pre-discharge health training session where nurses teach key healthy 33 behaviors and help mothers and family members learn skills and practice in the hospital. Here, we 34 assessed the impact of CCP on NMR. We conducted a quasi-experimental study to assess the effect of 35 the CCP sessions on mortality outcomes among families seeking care in 28 public tertiary facilities, 36 across 4 Indian states. Neonatal mortality outcomes were reported post-discharge, collected via phone 37 surveys at four weeks of age of baby, between October 2018 to February 2020. Risk ratios (RR), 38 adjusting for hospital-level clustering, were calculated by comparing mortality rates before and after 39 CCP implementation. A total of 46,428 families participated in the pre-intervention group and 87,305 in 40 the post-intervention group; 76% of families participated in the phone survey. The crude NMR was 41 33.64 deaths per 1000 live births (RR=0.82, 95% CI: 0.76, 0.87). After accounting for hospital-clustering, 42 the NMR was 41.3 (adjusted RR=0.81, 95% CI: 0.71, 0.93). There may be a substantial benefit to family-43 centered education in the early postnatal period to reduce neonatal mortality. 44