Community-based women's groups that address issues surrounding childbirth and care could reduce neonatal mortality in poor rural areas by 30%, say investigators in this week's issue of The Lancet.
0f the 4 million neonatal deaths every year, 98% occur in developing countries. In Makwanpur district, Nepal, most women give birth at home, and trained attendance at delivery is uncommon. Dharma S Manandhar (Mother and Infant Research Activities, Katmandu, Nepal) and colleagues cluster-randomised 24 village development communities with more than 28 000 people, half to intervention and half to control.
In each intervention cluster, a literate locally resident female facilitator was briefly trained in health issues related to pregnancy and birth. These facilitators convened monthly meetings in which married women of reproductive potential discussed health issues to do with childbirth, and participated in schemes to address concerns that were raised.
The neonatal mortality rate in intervention clusters was 26.2 per 1000, compared with 36.9 per 1000 in control clusters. Although maternal mortality was not a primary outcome of the trial, it was about 80% lower in intervention clusters (69 per 1000 compared with 341 per 1000). Women in intervention clusters were more likely to have received antenatal care, have given birth in a health facility with a trained attendant present, and to have used hygienic care.
The authors conclude: "a demand-side intervention can achieve great reductions in neonatal and maternal mortality in poor and remote communities. The approach-a local woman facilitating women's groups-is potentially acceptable, scalable, sustainable, and cost effective as a public-health intervention".
In an accompanying commentary (914), Ardythe Morrow and Adekunle Dawodu (Children's Hospital Medical Center, Cincinnati, USA) discuss how interventions such as this one could help meet the Millennium Development Goal to reduce child mortality. "The millennium goal for child survival, although it might appear ambitious, could be achieved using known interventions. Thus, the most fundamental constraint in improving child survival is the failure of delivery… But to achieve the millennium goals, this study is not the end, it is only part of the beginning."
Contact: Joanna Robert, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK;
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Ardythe L Morrow, Children's Hospital Medical Center, Center for Epidemiology and Biostatistics, Cincinnati, OH 45229, USA;
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