An Intervention to Enhance Obstetric and Newborn Care in India: A Cluster Randomized-Trial

Shivaprasad S. Goudar, Richard J. Derman, Narayan V. Honnungar, Kamal P. Patil, Mallaiah K. Swamy, Janet Moore, Dennis D. Wallace, Elizabeth M. McClure, Bhalchandra S. Kodkany, Omrana Pasha, Nancy L. Sloan, Linda L. Wright, Robert L. Goldenberg

Research output: Contribution to journalArticlepeer-review

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 ≥1000 g, respectively, were enrolled and 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.

Original languageEnglish (US)
Pages (from-to)2698-2706
Number of pages9
JournalMaternal and child health journal
Volume19
Issue number12
DOIs
StatePublished - Dec 1 2015

Keywords

  • Community mobilization
  • Emergency obstetric and newborn care
  • India
  • Neonatal mortality
  • Perinatal mortality
  • Quality of care

ASJC Scopus subject areas

  • Epidemiology
  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology
  • Public Health, Environmental and Occupational Health

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