Perinatal mortality in rural India: intervention through primary health care. II Neonatal mortality.

SUMMARY Early neonatal mortality is unacceptably high in most developing countries. A large majority of births in rural areas of these countries occur at home, attended by relatives or traditional birth attendants and without easy access to skilled professional care. Under these circumstances cause of death has to be based on lay descriptions of terminal events. Analysis of cause of death shows that 74 % of the early neonatal deaths are amenable to intervention. Admittance to hospital of the "at risk " neonates is not practicable. Intervention through primary health care can be effective if based on scientific principles and offered through female community health workers. Objectives of domiciliary care given by these workers should be to educate and guide the mother to protect the delicate newborn from the effects of adverse environmental conditions, to ensure adequate nutrition, and to prevent infections. Interventions supporting beneficial traditional cultural practices as well as simple techniques for care of the newborn are discussed. Survival of the newborn during the first week of life is determined by the stresses of intrauterine life and the birth process, as well as by the adjustment to a ne