Lufwanyama Neonatal Survival Project (LUNESP)

Project Description

In Zambia’s Lufwanyama district, a mother going into labor may have to walk more than 7 hours to reach the nearest health facility. As a result, many women end up delivering at home. Traditional birth attendants—women in the community who have some basic midwifery training—assist with about 40% of home deliveries. Unfortunately, even with their help, the neonatal death rate is estimated to be more than ten times higher than the rate in the U.S.

The goal of the CGHD’s Lufwanyama Neonatal Survival Project (LUNESP) was to teach local birth attendants to recognize and treat infants at risk of illness and death as soon as they are born and to determine whether this intervention would make a difference in reducing neonatal mortality in a rural setting. For example, Lufwanyama birth attendants were given dry towels, to wrap the newborn to help prevent hypothermia, and equipped with suction bulbs, to clear the infants’ airways. They carried pocket resuscitators for use in case the newborns had trouble breathing. In the event that a baby appeared to be ill, the women carried stand-by antibiotics with instructions to give the infant a first dose of amoxicillin and refer the child to the nearest health facility.

Over the duration of the study, Zambian infants delivered by traditional birth attendants who had been trained under LUNESP were nearly half as likely to die during their first month of life than infants delivered by traditional birth attendants who received no such training. This equated to one death averted for every 56 deliveries attended by an LUNESP-trained birth attendant, or a total reduction of about 18 deaths per 1000 live births. Putting this in context, in 2007 the countrywide neonatal mortality rate in Zambia was 34 per 1000 live births. We observed no difference in the proportion of stillborn infants between the two groups—an important point, since the study interventions should have had no effect on stillbirth rates.

LUNESP has spawned several new initiatives. Save the Children, a nonprofit organization working to improve the lives and health of youngsters in forty-two countries worldwide, has been in contact with the research team and has raised funds to continue the intervention program throughout the Lufwanyama district for the next five years. Through a project called LINCHPIN, the CGHD will remain a partner in that effort.

This project is one activity of the CGHD’s Child and Family Applied Research project (CFAR).

Project Details

Principal Investigator Christopher Gill
Boston University Co-Investigators Davidson Hamer, William MacLeodLora Sabin
  • Mark Mirochnick, Department of Pediatrics, Boston Medical Center
  • Christopher Gill
  • Nicholas Guerina, Tufts Medical Center
  • Grace Mazala, Lufwanyama District Health Management Team
Country(ies) Zambia
Dates of Research 2006–2008