Community health promotion and medical provision for neonatal health-CHAMPION cluster randomised trial in Nagarkurnool district, Telangana (formerly Andhra Pradesh), India

Autor: RM Mukherjee, Vera Mann, Rashmi Lakshminarayana, Chris Frost, Gilda Piaggio, Alex Eble, Peter Boone, Chitra Jayanty, Padmanabh Reddy, Diana Elbourne
Jazyk: angličtina
Rok vydání: 2017
Předmět:
Male
Rural Population
Epidemiology
Maternal Health
Health Behavior
Psychological intervention
lcsh:Medicine
Pediatrics
Neonatal Care
Geographical Locations
Labor and Delivery
0302 clinical medicine
RJ101 Child Health. Child health services
Pregnancy
RA0421 Public health. Hygiene. Preventive Medicine
Infant Mortality
Health care
Medicine and Health Sciences
Medicine
Public and Occupational Health
Community Health Services
030212 general & internal medicine
education.field_of_study
Mortality rate
Child Health
Obstetrics and Gynecology
General Medicine
Health Education and Awareness
Community health
Female
Health education
Research Article
medicine.medical_specialty
Asia
Death Rates
Population
India
Health Promotion
03 medical and health sciences
Nursing
Humans
Infant Health
education
Demography
business.industry
lcsh:R
Infant
Newborn
Biology and Life Sciences
Neonates
Infant
HQ The family. Marriage. Woman
Infant mortality
Health Care
Health promotion
Family medicine
People and Places
Birth
Women's Health
Newborn infants--Death
Neonatology
business
030217 neurology & neurosurgery
Developmental Biology
Zdroj: PLoS Medicine, Vol 14, Iss 7, p e1002324 (2017)
PLoS Medicine
ISSN: 1549-1676
1549-1277
Popis: Background In the mid-2000s, neonatal mortality accounted for almost 40% of deaths of children under 5 years worldwide, and constituted 65% of infant deaths in India. The neonatal mortality rate in Andhra Pradesh was 44 per 1,000 live births, and was higher in the rural areas and tribal regions, such as the Nagarkurnool division of Mahabubnagar district (which became Nagarkurnool district in Telangana in 2014). The aim of the CHAMPION trial was to investigate whether a package of interventions comprising community health promotion and provision of health services (including outreach and facility-based care) could lead to a reduction of the order of 25% in neonatal mortality. Methods and findings The design was a trial in which villages (clusters) in Nagarkurnool with a population < 2,500 were randomised to the CHAMPION package of health interventions or to the control arm (in which children aged 6–9 years were provided with educational interventions—the STRIPES trial). A woman was eligible for the CHAMPION package if she was married and
In CHAMPION, a cluster-randomized trial carried out in rural India, Diana Elbourne and colleagues investigate the benefit of a package of interventions for neonatal care.
Author summary Why was this study done? At the time this study was planned, the rate of death of children in the first 28 days of life was very high in parts of rural India. Earlier research had suggested that community health promotion, along with buttressing existing maternity and neonatal services, might reduce this rate. What did the researchers do and find? We randomised small villages in the Nagarkurnool district in Telangana either to the package of health interventions or to control. We provided married women in the intervention villages with community health promotion (including health education via village health worker–led participatory discussion groups), outreach (including mobile teams providing antenatal check-ups), and facility-based care (including subsidised access to non-public health centres). We enrolled 14,137 women in 232 control villages and 15,532 in 232 intervention villages. In all, 4,885 control women had 5,474 eligible pregnancies and gave birth to 4,998 eligible children. The corresponding numbers in intervention villages were 5,664 women, 6,351 pregnancies, and 5,798 children. We found that, of the live-born babies, 343 (6.9%) in the control arm and 303 (5.2%) in the intervention arm died in their first 28 days of life, suggesting that there were 92 fewer deaths as a result of the intervention. We also found evidence of improved health knowledge and health practices including health service usage in the intervention arm compared to the control arm. What do these findings mean? The research findings mean that interventions such as those in the CHAMPION trial can be strongly justified in much of rural India. Further research is needed to assess whether the interventions are of use in other rural settings with similar socioeconomic and cultural patterns, similar neonatal mortality rates, and the existence of some private health provision.
Databáze: OpenAIRE
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