Effectiveness of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial
| Autor: | Hemanta Pradhan, Amit Ojha, Andrew Copas, Rajkumar Gope, Audrey Prost, Shibanand Rath, Suchitra Rath, Manir Ahmed, Parabita Basu, Vasudha Chakravarthy, Akay Minz, Riza Mahanta, Hassan Haghparast-Bidgoli, Amit Kumar, Vikash Nath, Prasanta Tripathy, Nirmala Nair, Tanja A. J. Houweling, Pradeep Baskey |
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| Přispěvatelé: | Public Health |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Rural Population
medicine.medical_specialty Medicine (General) Population India Infectious and parasitic diseases RC109-216 Disease cluster maternal health law.invention R5-920 SDG 3 - Good Health and Well-being Randomized controlled trial law Intervention (counseling) Infant Mortality medicine Humans Women education Original Research education.field_of_study Government business.industry Health Policy Public health Public Health Environmental and Occupational Health Infant Newborn Eastern india Scale (social sciences) child health Female Public Health business Demography |
| Zdroj: | BMJ Global Health, Vol 6, Iss 11 (2021) BMJ Global Health BMJ Global Health, 6(11):e005066. BMJ Publishing Group |
| ISSN: | 2059-7908 |
| Popis: | IntroductionThe WHO recommends community mobilisation with women’s groups practising participatory learning and action (PLA) to improve neonatal survival in high-mortality settings. This intervention has not been evaluated at scale with government frontline workers.MethodsWe did a pragmatic cluster non-randomised controlled trial of women’s groups practising PLA scaled up by government front-line workers in Jharkhand, eastern India. Groups prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies and evaluated progress. Intervention coverage and quality were tracked state-wide. Births and deaths to women of reproductive age were monitored in six of Jharkhand’s 24 districts: three purposively allocated to an early intervention start (2017) and three to a delayed start (2019). We monitored vital events prospectively in 100 purposively selected units of 10 000 population each, during baseline (1 March 2017–31 August 2017) and evaluation periods (1 September 2017–31 August 2019). The primary outcome was neonatal mortality.ResultsWe identified 51 949 deliveries and conducted interviews for 48 589 (93.5%). At baseline, neonatal mortality rates (NMR) were 36.9 per 1000 livebirths in the early arm and 39.2 in the delayed arm. Over 24 months of intervention, the NMR was 29.1 in the early arm and 39.2 in the delayed arm, corresponding to a 24% reduction in neonatal mortality (adjusted OR (AOR) 0.76, 95% CI 0.59 to 0.98), including 26% among the most deprived (AOR 0.74, 95% CI 0.57 to 0.95). Twenty of Jharkhand’s 24 districts achieved adequate meeting coverage and quality. In these 20 districts, the intervention saved an estimated 11 803 newborn lives (min: 1026–max: 20 527) over 42 months, and cost 41 international dollars per life year saved.ConclusionParticipatory women’s groups scaled up by the Indian public health system reduced neonatal mortality equitably in a largely rural state and were highly cost-effective, warranting scale-up in other high-mortality rural settings.Trial registrationISRCTN99422435. |
| Databáze: | OpenAIRE |
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