Cost-effectiveness of essential newborn care training in urban first-level facilities

Pediatrics. 2011 May;127(5):e1176-81. doi: 10.1542/peds.2010-2158. Epub 2011 Apr 18.


Objective: To determine the cost-effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) training of health care providers in first-level facilities in the 2 largest cities in Zambia.

Methods: Data were extracted from a study in which the effectiveness of the ENC training was evaluated (including universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, skin-to-skin care, care of the small infant, danger signs, and common illnesses). The costs to train an ENC instructor for each first-level delivery facility and the costs of salary/benefits for 2 coordinators responsible for maintenance of the program were recorded in 2005 US dollars. The incremental costs per life gained and per disability-adjusted life-year averted were calculated.

Setting: A 5-day ENC training-of-trainers was conducted in Lusaka, Zambia, to certify 18 college-trained midwives as ENC instructors. The instructors trained all clinic midwives working in their first-level facilities as part of a before-and-after study of the effect of ENC training on early neonatal mortality conducted from Oct 2004 to Nov 2006.

Results: All-cause 7-day (early) neonatal mortality decreased from 11.5 per 1000 to 6.8 per 1000 live births after ENC training of the clinic midwives (relative risk: 0.59; 95% confidence interval: 0.48-0.77; P < .001; 40 615 births). The intervention costs were $208 per life saved and $5.24 per disability-adjusted life-year averted.

Conclusions: ENC training of clinic midwives who provide care in low-risk facilities is a low-cost intervention that can reduce early neonatal mortality in these settings.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Ambulatory Care / organization & administration
  • Cost-Benefit Analysis
  • Developing Countries
  • Female
  • Health Care Costs
  • Health Personnel / economics*
  • Health Personnel / education
  • Humans
  • Infant Care / economics*
  • Infant Care / standards
  • Infant Mortality / trends*
  • Infant, Newborn
  • Male
  • Nurse Midwives / economics
  • Nurse Midwives / education*
  • Pediatric Nursing / education
  • Program Evaluation
  • Risk Assessment
  • World Health Organization
  • Zambia