The problem Close to 4 million deaths occur in the first 28 days of life (the neonatal or newborn period) in the world each year; 40% of all under-five deaths – most within 7 days of birth; Three main causes – infections, asphyxia, and preterm birth – account for nearly 80% of these deaths.

Deaths that could be prevented Up to two thirds of newborn deaths could be prevented if known, effective health measures were provided at birth and during the first week of life; Yet 47% of all mothers and newborns in developing countries do not receive skilled care during and immediately after birth, and 72% of all babies born outside the hospital do not receive any postnatal care.

Home visits for newborn care by a trained health worker can save lives

Effectiveness of home visits for newborn care

Recommendation: Home care visits on days one and three of a newborn's life, and if possible, a third visit on day seven. Health workers should: Promote early and exclusive breastfeeding; Help keep the newborn warm; Promote hygienic umbilical cord and skin care; Assess the baby for signs of problems - seek prompt medical care if so Promote birth registration and timely vaccination; Identify and support additional care to low-birth-weight, sick newborns or those who have an HIV-infected mother; and Ask and counsel the mother about her own health.

Examples of workers in existing government programmes Community midwives in Indonesia Community workers of the Integrated Management of Neonatal and Childhood Illness (IMNCI) programme in India Female community health volunteers in Nepal Health Surveillance Assistants (HSAs) in Malawi Health extension workers in Ethiopia

Recommendations for countries All newborns should receive appropriate care especially in the first hours and week of life when they are most vulnerable; Each country should analyse the current policies and practices to provide such care; A home visitation programme is recommended where access to facility-based skilled care is limited; Home visits should be initiated as soon as possible after birth or after returning home; and Postnatal home care by community health workers should be linked to the health system and the full continuum of care.