Perinatal Care Project, Diabetic Association of Bangladesh, Shahbagh, Dhaka, Bangladesh.
Lancet. 2010 Apr 3;375(9721):1193-202. doi: 10.1016/S0140-6736(10)60142-0. Epub 2010 Mar 6.
Two recent trials have shown that women's groups can reduce neonatal mortality in poor communities. We assessed the effectiveness of a scaled-up development programme with women's groups to address maternal and neonatal care in three rural districts of Bangladesh.
18 clusters (with a mean population of 27 953 [SD 5953]) in three districts were randomly assigned to either intervention or control (nine clusters each) by use of stratified randomisation. For each district, cluster names were written on pieces of paper, which were folded and placed in a bottle. The first three cluster names drawn from the bottle were allocated to the intervention group and the remaining three to control. All clusters received health services strengthening and basic training of traditional birth attendants. In intervention clusters, a facilitator convened 18 groups every month to support participatory action and learning for women, and to develop and implement strategies to address maternal and neonatal health problems. Women were eligible to participate if they were aged 15-49 years, residing in the project area, and had given birth during the study period (Feb 1, 2005, to Dec 31, 2007). Neither study investigators nor participants were masked to treatment assignment. In a population of 229 195 people (intervention clusters only), 162 women's groups provided coverage of one group per 1414 population. The primary outcome was neonatal mortality rate (NMR). Analysis was by intention to treat. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN54792066.
We monitored outcomes for 36 113 births (intervention clusters, n=17 514; control clusters, n=18 599) in a population of 503 163 over 3 years. From 2005 to 2007, there were 570 neonatal deaths in the intervention clusters and 656 in the control clusters. Cluster-level mean NMR (adjusted for stratification and clustering) was 33.9 deaths per 1000 livebirths in the intervention clusters compared with 36.5 per 1000 in the control clusters (risk ratio 0.93, 95% CI 0.80-1.09).
For participatory women's groups to have a significant effect on neonatal mortality in rural Bangladesh, detailed attention to programme design and contextual factors, enhanced population coverage, and increased enrolment of newly pregnant women might be needed.
Women and Children First, the UK Big Lottery Fund, Saving Newborn Lives, and the UK Department for International Development.
两项近期试验表明，妇女团体可降低贫困社区的新生儿死亡率。我们评估了扩大妇女团体发展计划以解决孟加拉国三个农村地区产妇和新生儿护理问题的效果。
通过分层随机化，将三个地区的 18 个集群（平均人口为 27953[SD5953]）随机分为干预组或对照组（每组 9 个集群）。对于每个地区，集群名称写在纸条上，折叠并放入瓶中。从瓶中抽取的前三个集群名称被分配到干预组，其余三个被分配到对照组。所有集群都接受了卫生服务加强和传统助产妇的基本培训。在干预集群中，一名协调员每月召集 18 个小组，支持妇女参与行动和学习，并制定和实施解决产妇和新生儿健康问题的策略。如果妇女年龄在 15-49 岁之间，居住在项目区，并在研究期间（2005 年 2 月 1 日至 2007 年 12 月 31 日）分娩，她们就有资格参加。研究调查人员和参与者均未对治疗分配进行掩蔽。在 229195 人的人群中（仅干预集群），162 个妇女团体提供了每 1414 人一组的覆盖范围。主要结局是新生儿死亡率（NMR）。分析采用意向治疗。该试验在国际标准随机对照试验注册中心（ISRCTN）注册，编号为 ISRCTN54792066。
我们在 3 年期间监测了 503163 人口中 36113 次分娩的结局（干预集群 n=17514；对照组 n=18599）。2005 年至 2007 年，干预集群中有 570 名新生儿死亡，对照组中有 656 名新生儿死亡。在调整分层和聚类后，集群水平的平均 NMR（调整后的）为干预集群中每 1000 例活产 33.9 例死亡，而对照组中每 1000 例活产 36.5 例死亡（风险比 0.93，95%CI0.80-1.09）。
为了使参与式妇女团体对孟加拉国农村地区的新生儿死亡率产生重大影响，可能需要详细关注方案设计和背景因素、增强人口覆盖范围以及增加新孕妇的入学率。
妇女和儿童第一、英国大彩票基金、拯救新生儿生命和英国国际发展部。
