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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A combined community- and facility-based approach to improve pregnancy outcomes in low-resource settings: A Global Network cluster randomized trial
BMC Medicine, Volume 11, No. 1, Article 215, Year 2013
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Description
Background: Fetal and neonatal mortality rates in low-income countries are at least 10-fold greater than in high-income countries. These differences have been related to poor access to and poor quality of obstetric and neonatal care. Methods: This trial tested the hypothesis that teams of health care providers, administrators and local residents can address the problem of limited access to quality obstetric and neonatal care and lead to a reduction in perinatal mortality in intervention compared to control locations. In seven geographic areas in five low-income and one middle-income country, most with high perinatal mortality rates and substantial numbers of home deliveries, we performed a cluster randomized non-masked trial of a package of interventions that included community mobilization focusing on birth planning and hospital transport, community birth attendant training in problem recognition, and facility staff training in the management of obstetric and neonatal emergencies. The primary outcome was perinatal mortality at ≥28 weeks gestation or birth weight ≥1000 g. Results: Despite extensive effort in all sites in each of the three intervention areas, no differences emerged in the primary or any secondary outcome between the intervention and control clusters. In both groups, the mean perinatal mortality was 40.1/1,000 births (P = 0.9996). Neither were there differences between the two groups in outcomes in the last six months of the project, in the year following intervention cessation, nor in the clusters that best implemented the intervention. Conclusions: This cluster randomized comprehensive, large-scale, multi-sector intervention did not result in detectable impact on the proposed outcomes. While this does not negate the importance of these interventions, we expect that achieving improvement in pregnancy outcomes in these settings will require substantially more obstetric and neonatal care infrastructure than was available at the sites during this trial, and without them provider training and community mobilization will not be sufficient. Our results highlight the critical importance of evaluating outcomes in randomized trials, as interventions that should be effective may not be.Trial registration: ClinicalTrials.gov NCT01073488. © 2013 Pasha et al.; licensee BioMed Central Ltd.
Authors & Co-Authors
Pasha, Omrana
Pakistan, Karachi
The Aga Khan University
McClure, Elizabeth M.
United States, Research Triangle Park
Rti International
Wright, Linda L.
United States, Bethesda
National Institute of Child Health and Human Development Nichd
Saleem, Sarah
Pakistan, Karachi
The Aga Khan University
Goudar, Shivaprasad S.
India, Belgaum
Jawaharlal Nehru Medical College Belgaum
Chomba, Elwyn Nachanya
Zambia, Lusaka
University Teaching Hospital Lusaka
Patel, Archana Behram
India, Nagpur
Government Medical College Nagpur
Esamai, Fabian O.
Kenya, Eldoret
Moi University
Garcés, Ana Lucía
Guatemala, Guatemala City
Universidad Francisco Marroquin
Althabe, Fernando A.
Argentina, Buenos Aires
Institute for Clinical Effectiveness and Health Policy, Ciudad Autonoma de Buenos Aires
Kodkany, Bhalachandra S.
India, Belgaum
Jawaharlal Nehru Medical College Belgaum
Mabeya, Hillary M.
Kenya, Eldoret
Moi University
Manasyan, Albert
Zambia, Lusaka
Centre for Infectious Disease Research
Carlo, Waldemar A.
United States, Birmingham
The University of Alabama at Birmingham
Derman, Richard J.
United States, Wilmington
Christiana Care Health System
Hibberd, Patricia L.
United States, Boston
Massachusetts General Hospital
Liechty, Edward A.
United States, Indianapolis
Indiana University-purdue University Indianapolis
Krebs, Nancy F.
United States, Denver
University of Colorado Denver
Hambidge, K. Michael
United States, Denver
University of Colorado Denver
Buekens, Pierre M.
United States, New Orleans
Tulane University School of Public Health and Tropical Medicine
Moore, Janet L.
United States, Research Triangle Park
Rti International
Jobe, Alan Hall
United States, Cincinnati
University of Cincinnati
Koso-Thomas, Marion W.
United States, Bethesda
National Institute of Child Health and Human Development Nichd
Wallace, Dennis D.
United States, Research Triangle Park
Rti International
Stalls, Suzanne
United States, Washington
American College of Nurse-midwives
Goldenberg, Robert L.
United States, New York
Columbia University
Mazzoni, Agustina
Unknown Affiliation
Laski, Marina
Unknown Affiliation
Karolinski, Ariel
Unknown Affiliation
Berrueta, Mabel B.
Unknown Affiliation
Kaseba, Christine M.
Zambia, Lusaka
University of Zambia
Morales, Evelyn
Guatemala, Guatemala City
Imsalud
Mahantshetti, Niranjana S.
India, Belgaum
Jawaharlal Nehru Medical College Belgaum
Honnungar, Narayan V.
India, Belgaum
Jawaharlal Nehru Medical College Belgaum
Patil, Kamal
India, Belgaum
Jawaharlal Nehru Medical College Belgaum
Swamy, M. K.
India, Belgaum
Jawaharlal Nehru Medical College Belgaum
Ahsan, Sadiah
Pakistan, Karachi
The Aga Khan University
Hussain, Khadim
Pakistan, Karachi
The Aga Khan University
Ahsan, Azra
Pakistan, Karachi
The Aga Khan University
Waikar, Manju
India, Nagpur
Indira Ghandi Medical School
Kulkarni, Nivedita
India, Nagpur
Indira Ghandi Medical School
Thakre, Sushama
India, Nagpur
Indira Ghandi Medical School
Bhatnagar, Manoj
India, Nagpur
Indira Ghandi Medical School
Rono, B.
Kenya, Eldoret
Moi University
Gisore, Peter O.
Kenya, Eldoret
Moi University
Mbeya, Hillary
Kenya, Eldoret
Moi University
Statistics
Citations: 60
Authors: 46
Affiliations: 22
Identifiers
Doi:
10.1186/1741-7015-11-215
e-ISSN:
17417015
Research Areas
Health System And Policy
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Randomised Control Trial