Ekjut, Chakradharpur, Jharkhand, India.
Institute for Global Health, University College London, London, UK.
Lancet Glob Health. 2016 Feb;4(2):e119-28. doi: 10.1016/S2214-109X(15)00287-9.
A quarter of the world's neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country's government-approved Accredited Social Health Activists (ASHAs). We aimed to test the effect of participatory women's groups facilitated by ASHAs on birth outcomes, including neonatal mortality.
In this cluster-randomised controlled trial of a community intervention to improve maternal and newborn health, we randomly assigned (1:1) geographical clusters in rural Jharkhand and Odisha, eastern India to intervention (participatory women's groups) or control (no women's groups). Study participants were women of reproductive age (15-49 years) who gave birth between Sept 1, 2009, and Dec 31, 2012. In the intervention group, ASHAs supported women's groups through a participatory learning and action meeting cycle. Groups discussed and prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies, and assessed their progress. We identified births, stillbirths, and neonatal deaths, and interviewed mothers 6 weeks after delivery. The primary outcome was neonatal mortality over a 2 year follow up. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN31567106.
Between September, 2009, and December, 2012, we randomly assigned 30 clusters (estimated population 156 519) to intervention (15 clusters, estimated population n=82 702) or control (15 clusters, n=73 817). During the follow-up period (Jan 1, 2011, to Dec 31, 2012), we identified 3700 births in the intervention group and 3519 in the control group. One intervention cluster was lost to follow up. The neonatal mortality rate during this period was 30 per 1000 livebirths in the intervention group and 44 per 1000 livebirths in the control group (odds ratio [OR] 0.69, 95% CI 0·53-0·89).
ASHAs can successfully reduce neonatal mortality through participatory meetings with women's groups. This is a scalable community-based approach to improving neonatal survival in rural, underserved areas of India.
Big Lottery Fund (UK).
全球四分之一的新生儿死亡和 15%的产妇死亡发生在印度。通过政府批准的认证社会卫生活动家（ASHA），很少有基于社区的策略来改善产妇和新生儿的健康状况。我们旨在通过 ASHA 促进的参与式妇女团体来检验对母婴健康的影响，包括新生儿死亡率。
在这项改善母婴健康的社区干预的集群随机对照试验中，我们按 1：1 的比例将印度东部的恰尔康得和奥里萨邦的地理集群随机分配到干预组（参与式妇女团体）或对照组（无妇女团体）。研究参与者是育龄妇女（15-49 岁），她们于 2009 年 9 月 1 日至 2012 年 12 月 31 日分娩。在干预组中，ASHA 通过参与式学习和行动会议周期支持妇女团体。团体讨论并确定了产妇和新生儿健康问题的优先次序，确定了解决这些问题的策略，实施了这些策略，并评估了进展情况。我们确定了分娩、死产和新生儿死亡，并在产后 6 周时对母亲进行了访谈。主要结局是 2 年随访期间的新生儿死亡率。分析是基于意向治疗。这项试验在 ISRCTN 注册，编号为 ISRCTN31567106。
2009 年 9 月至 2012 年 12 月期间，我们随机分配了 30 个集群（估计人口 156519 人）到干预组（15 个集群，估计人口 n=82702 人）或对照组（15 个集群，n=73817 人）。在随访期间（2011 年 1 月 1 日至 2012 年 12 月 31 日），我们在干预组中确定了 3700 例分娩，在对照组中确定了 3519 例分娩。一个干预组集群失去了随访。在此期间，干预组的新生儿死亡率为每 1000 例活产 30 例，对照组为每 1000 例活产 44 例（比值比[OR]0.69，95%CI0.53-0.89）。
ASHA 可以通过与妇女团体的参与式会议成功降低新生儿死亡率。这是一种在印度农村和服务不足地区改善新生儿生存的可扩展的基于社区的方法。
大彩票基金（英国）。
