Effects of Essential Newborn Care Training on Fresh Stillbirths and Early Neonatal Deaths by Maternal Education

Neonatology. 2017;111(1):61-67. doi: 10.1159/000447421. Epub 2016 Aug 20.


Background: Infants of women with lower education levels are at higher risk for perinatal mortality.

Objectives: We explored the impact of training birth attendants and pregnant women in the Essential Newborn Care (ENC) Program on fresh stillbirths (FSBs) and early (7-day) neonatal deaths (END) by maternal education level in developing countries.

Methods: A train-the-trainer model was used with local instructors in rural communities in six countries (Argentina, Democratic Republic of the Congo, Guatemala, India, Pakistan, and Zambia). Data were collected using a pre-/post-active baseline controlled study design.

Results: A total of 57,643 infants/mothers were enrolled. The follow-up rate at 7 days of age was 99.2%. The risk for FSB and END was higher for mothers with 0-7 years of education than for those with ≥8 years of education during both the pre- and post-ENC periods in unadjusted models and in models adjusted for confounding. The effect of ENC differed as a function of maternal education for FSB (interaction p = 0.041) without evidence that the effect of ENC differed as a function of maternal education for END. The model-based estimate of FSB risk was reduced among mothers with 0-7 years of education (19.7/1,000 live births pre-ENC, CI: 16.3, 23.0 vs. 12.2/1,000 live births post-ENC, CI: 16.3, 23.0, p < 0.001), but was not significantly different for mothers with ≥8 years of education, respectively.

Conclusion: A low level of maternal education was associated with higher risk for FSB and END. ENC training was more effective in reducing FSB among mothers with low education levels.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Africa
  • Asia
  • Developing Countries
  • Educational Status*
  • Female
  • Humans
  • Infant
  • Infant Mortality*
  • Infant, Newborn
  • Intensive Care, Neonatal / standards*
  • Latin America
  • Logistic Models
  • Male
  • Multivariate Analysis
  • Pregnancy
  • Risk Assessment
  • Stillbirth / epidemiology*
  • Young Adult