An Intervention to Enhance Obstetric and Newborn Care in India: A Cluster Randomized-Trial
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An Intervention to Enhance Obstetric and Newborn Care in India: A Cluster Randomized-Trial Shivaprasad S. Goudar1 • Richard J. Derman2 • Narayan V. Honnungar1 • Kamal P. Patil1 • Mallaiah K. Swamy1 • Janet Moore3 • Dennis D. Wallace3 Elizabeth M. McClure3 • Bhalchandra S. Kodkany1 • Omrana Pasha4 • Nancy L. Sloan2 • Linda L. Wright5 • Robert L. Goldenberg6
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Ó Springer Science+Business Media New York 2015
Abstract Objectives This study assessed whether community mobilization and interventions to improve emergency obstetric and newborn care reduced perinatal mortality (PMR) and neonatal mortality rates (NMR) in Belgaum, India. Methods The cluster-randomised controlled trial was conducted in Belgaum District, Karnataka State, India. Twenty geographic clusters were randomized to control or the intervention. The intervention engaged and mobilized community and health authorities to leverage support; strengthened community-based stabilization, referral, and transportation; and aimed to improve quality of care at facilities. Results 17,754 Intervention births and 15,954 control births weighing C1000 g, respectively, were enrolled and
& Elizabeth M. McClure [email protected] 1
Women’s and Children’s Health Research Unit, KLE University’s Jawaharlal Nehru Medical College, Belgaum, India
2
Department of Obstetrics and Gynaecology, Christiana Care Health Services, Newark, DE, USA
3
Social, Statistical, and Environmental Health Sciences, Research Triangle Institute, Research Triangle Park, Durham, NC 27709, USA
4
Aga Khan University, Karachi, Pakistan
5
Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA
6
Department of Obstetrics and Gynaecology, Columbia University, New York, NY, USA
analysed. Comparing the baseline period to the last 6 months period, the NMR was lower in the intervention versus control clusters (OR 0.60, 95 % CI 0.34–1.06, p = 0.076) as was the PMR (OR 0.74, 95 % CI 0.46–1.19, p = 0.20) although neither reached statistical significance. Rates of facility birth and caesarean section increased among both groups. There was limited influence on quality of care measures. Conclusions for Practice The intervention had large but not statistically significant effects on neonatal and perinatal mortality. Community mobilization and increased facility care may ultimately improve neonatal and perinatal survival, and are important in the context of the global transition towards institutional delivery. Keywords Emergency obstetric and newborn care Perinatal mortality Neonatal mortality Community mobilization Quality of care India
Significance To date, community mobilization research has primarily assessed impact of the intervention on essential newborn care and referrals. Our cluster-randomized trial, evaluated a community mobilization package on practices in the community but also on the population-based perinatal and neonatal mortality rates in an Indian site. While we found high fidelity to the intervention including increased facility delivery r
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