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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: A systematic review and meta-analysis
The Lancet, Volume 381, No. 9879, Year 2013
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Description
Background: Maternal and neonatal mortality rates remain high in many low-income and middle-income countries. Different approaches for the improvement of birth outcomes have been used in community-based interventions, with heterogeneous effects on survival. We assessed the effects of women's groups practising participatory learning and action, compared with usual care, on birth outcomes in low-resource settings. Methods: We did a systematic review and meta-analysis of randomised controlled trials undertaken in Bangladesh, India, Malawi, and Nepal in which the effects of women's groups practising participatory learning and action were assessed to identify population-level predictors of effect on maternal mortality, neonatal mortality, and stillbirths. We also reviewed the cost-effectiveness of the women's group intervention and estimated its potential effect at scale in Countdown countries. Findings: Seven trials (119 428 births) met the inclusion criteria. Meta-analyses of all trials showed that exposure to women's groups was associated with a 37% reduction in maternal mortality (odds ratio 0·63, 95% CI 0·32-0·94), a 23% reduction in neonatal mortality (0·77, 0·65-0·90), and a 9% non-significant reduction in stillbirths (0·91, 0·79- 1·03), with high heterogeneity for maternal (I2=58·8%, p=0·024) and neonatal results (I2=64·7%, p=0·009). In the meta-regression analyses, the proportion of pregnant women in groups was linearly associated with reduction in both maternal and neonatal mortality (p=0·026 and p=0·011, respectively). A subgroup analysis of the four studies in which at least 30% of pregnant women participated in groups showed a 55% reduction in maternal mortality (0·45, 0·17-0·73) and a 33% reduction in neonatal mortality (0·67, 0·59-0·74). The intervention was cost effective by WHO standards and could save an estimated 283 000 newborn infants and 41 100 mothers per year if implemented in rural areas of 74 Countdown countries. Interpretation: With the participation of at least a third of pregnant women and adequate population coverage, women's groups practising participatory learning and action are a cost-effective strategy to improve maternal and neonatal survival in low-resource settings. © 2013. World Health Organization. Published by Elsevier Ltd/Inc/BV. All rights reserved.
Authors & Co-Authors
Prost, Audrey
United Kingdom, London
University College London
Colbourn, Tim E.
United Kingdom, London
University College London
Seward, Nadine
United Kingdom, London
University College London
Azad, Kishwar M.
Bangladesh, Dhaka
Diabetic Association of Bangladesh
Coomarasamy, Aravinthan
United Kingdom, Birmingham
University of Birmingham
Copas, Andrew J.
United Kingdom, London
University College London
Houweling, Tanja A.J.
United Kingdom, London
University College London
Netherlands, Rotterdam
Erasmus Mc
Fottrell, Edward F.
United Kingdom, London
University College London
Kuddus, Abdul
Bangladesh, Dhaka
Diabetic Association of Bangladesh
Lewycka, Sonia
United Kingdom, London
University College London
Malawi, Lilongwe
Maimwana Project
MacArthur, Christine
United Kingdom, Birmingham
University of Birmingham
Manandhar, Dharma Sharna
Nepal, Kathmandu
Mother and Infant Research Activities Mira
Morrison, Joanna
United Kingdom, London
University College London
Nepal, Kathmandu
Mother and Infant Research Activities Mira
Mwansambo, Charles C.V.
Malawi, Lilongwe
Ministry of Health Malawai
Nair, Nirmala
India, Ranchi
Ekjut
Nambiar, Bejoy
United Kingdom, London
University College London
Malawi, Lilongwe
Parent and Child Health Initiative
Osrin, David
United Kingdom, London
University College London
India, Sion
Chota Sion Hospital
Pagel, Christina
United Kingdom, London
University College London
Phiri, Tambosi
Malawi, Lilongwe
Maimwana Project
Pulkki-Brännström, Anni Maria
United Kingdom, London
University College London
Rosato, Mikey
United Kingdom, London
University College London
Malawi, Lilongwe
Maimwana Project
Skordis, Jolene
United Kingdom, London
University College London
Saville, Naomi M.
United Kingdom, London
University College London
Nepal, Kathmandu
Mother and Infant Research Activities Mira
More, Neena Shah
India, Sion
Chota Sion Hospital
Shrestha, Bhim Prasad
Nepal, Kathmandu
Mother and Infant Research Activities Mira
Tripathy, Prasanta
India, Ranchi
Ekjut
Wilson, Amie
United Kingdom, Birmingham
University of Birmingham
Costello, Anthony Ml De L.
United Kingdom, London
University College London
Statistics
Citations: 549
Authors: 28
Affiliations: 10
Identifiers
Doi:
10.1016/S0140-6736(13)60685-6
ISSN:
01406736
e-ISSN:
1474547X
Research Areas
Genetics And Genomics
Health System And Policy
Maternal And Child Health
Study Design
Randomised Control Trial
Cross Sectional Study
Case-Control Study
Study Approach
Systematic review
Study Locations
Malawi
Participants Gender
Female