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Neonatal death accounts for 25% of under-5 mortality in Africa. Many African countries will not achieve Millennium Development Goal 4 (a 2/3 reduction in under-5 mortality from the 1990 level by 2015) without reducing newborn deaths. Efforts to promote skilled birth attendance in Africa have largely assumed no role for trained traditional birth attendants (TBAs), despite families' continued use of TBAs where facility delivery and skilled birth attendance remain out of reach. Gill and colleagues considered the effect of training TBAs on newborn death in Lufwanyama District in rural Zambia.
This was a prospective, cluster randomised and controlled effectiveness study of trained TBAs (60 intervention and 67 control) and the newborns they delivered (1962 intervention and 1536 control after excluding 62 for data quality concerns) over a 30-month period through November 2008. The 127 clusters comprised one TBA and the newborns she delivered. All 118 TBAs had previously been trained in basic obstetric and newborn care. The intervention for 60 randomly selected …
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