Community-Based Interventions for Newborns in Ethiopia Study (COMBINE)

The Community Based Interventions for Newborns in Ethiopia (COMBINE) study evaluated a strengthened package of maternal and newborn health (MNH) services within Ethiopia’s HEP, including pregnancy and postnatal home visits by HEWs and community volunteers, and referral of newborns with danger signs to health centers for treatment. COMBINE also assessed integrating management of possible serious bacterial infection by HEWs at community health posts, when referral was not possible or accepted by the family.

COMBINE, a cluster randomized controlled trial, operated through Primary Health Care Units, working with approximately 270 HEWs and 3,500 volunteers. The 22 study clusters had a total population of over 640,000 and were in East Shoa and West Arsi Zones of Oromia Region, and in the Sidama Zone of the SNNP Region.

Through visits with their neighbors and through observation in the community, volunteers identified pregnant women, initiating a series of structured home visits during pregnancy and in the first week of life. In both arms of COMBINE, volunteers and HEWs counseled mothers and assessed danger signs in the newborn during postnatal visits. Volunteers referred newborns with danger signs to HEWs for further assessment. HEWs assessed, classified, and referred sick newborns to the health center. In the treatment arm, if a family was unable or unwilling to comply with referral, the HEW managed sick newborns with possible serious bacterial infection by administering antibiotics at the health post or in the home. The 7?day regimen included injectable gentamicin given every 24 hours by the HEW and amoxicillin syrup given 3 times a day by the caretaker.

Study results are expected to have important implications for the scale-up of community based newborn care.

Watch a video highlighting COMBINE: Saving Newborn Lives in Ethiopia

COMBINE was implemented by Save the Children’s Saving Newborn Lives (SNL) program in partnership with the Federal Ministry of Health, the Oromia and SNNP Health Bureaus, and John Snow Research and Training Institute, Inc. Collaborating institutions included the Ethiopian Pediatric Society, the London School of Hygiene and Tropical Medicine (LSHTM), the Johns Hopkins Bloomberg School of Public Health, UNICEF, and WHO. COMBINE was funded by the Bill and Melinda Gates Foundation through a grant to Save the Children. 

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