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Randomised controlled trial
Training birth attendants in rural Zambia in neonatal resuscitation, and the use of amoxicillin coupled with facilitated referral, reduces neonatal mortality
  1. David R Marsh1,
  2. Stephen N Wall2
  1. 1Save the Children, Amherst, Massachusetts, USA
  2. 2Save the Children, Washington, District of Columbia, USA
  1. Correspondence to David R Marsh
    Save the Children, 31 Wildflower Drive, Amherst, MA 01002, USA; dmarsh{at}

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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 …

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  • Competing interests DM is advising the Lufwanyama Integrated Newborn and Child Health Project to scale up LUNESP and to test, in partnership with Boston University, the feasibility of teaming TBAs with CHWs to deliver interventions from birth through age 5 years. SNW has no competing interests.