Effect of a participatory intervention with women' groups on birth outcomes in Nepal: cluster-randomised controlled trial
Effect of a participatory intervention with women' groups on birth outcomes in Nepal: cluster-randomised controlled trial
复制标题
DOI：
10.1016/s0140-6736(04)17021-9
复制
发表时间：
2004-09-11
期刊：
影响因子：
168.9
通讯作者：
Costello, AMD
中科院分区：
文献类型：
--
作者：
Manandhar, DS;Osrin, D;Costello, AMD
发展中国家的新生儿死亡是全球5岁以下儿童死亡率的最大原因。在最贫穷的五分之一家庭中，90%的分娩是在家里进行的。我们假设，以社区为基础的参与性干预可以显着降低新生儿死亡率。方法我们配对42地缘政治集群Makwanpur区，尼泊尔，随机选择12对，并随机分配每对干预或控制。在每个干预群组（平均人口7000人），一名女性主持人每月召开9次妇女小组会议。主持人通过一个行动学习周期，他们确定当地围产期支持团体。并制定了解决这些问题的战略。我们监测了28931名妇女的出生结果，其中8%加入了这些群体。主要结局为新生儿死亡率。其他结果包括死产和孕产妇死亡、产前和分娩服务的使用、家庭护理做法、婴儿发病率和寻求保健。该研究被注册为国际标准随机对照试验，编号ISRCTN 31137309。新生儿死亡率为26.2%.（每2899例活产76例死亡），而对照组为每1000例36.9例（每3226例活产119例死亡）（调整后的比值比为0。70 [95% CI 0 . 53-0.94]）。两组的死胎率相似。干预组的孕产妇死亡率为69/10万（每2899例活产2例死亡），而对照组为341/10万（每3226例活产11例死亡）（0.22 [0.05-0.90]）。干预集群中的妇女更有可能有产前保健，机构分娩，训练有素的助产士，卫生保健比controls.Interpretation出生在贫困农村人口的结果大大改善，通过低成本，潜在的可持续性和可扩展性，参与性干预与妇女团体。
Background Neonatal deaths in developing countries make the largest contribution to global mortality in children younger than 5 years. 90% of deliveries in the poorest quintile of households happen at home. We postulated that a community-based participatory intervention could significantly reduce neonatal mortality rates.Methods We pair-matched 42 geopolitical clusters in Makwanpur district, Nepal, selected 12 pairs randomly, and randomly assigned one of each pair to intervention or control. in each intervention cluster (average population 7000), a female facilitator convened nine women's group meetings every month. The facilitator supported groups through an action-learning cycle in which they identified local perinatal. problems and formulated strategies to address them. We monitored birth outcomes in a cohort of 28 931 women, of whom 8% joined the groups. The primary outcome was neonatal mortality rate. Other outcomes included stillbirths and maternal deaths, uptake of antenatal and delivery services, home care practices, infant morbidity, and health-care seeking. Analysis was by intention to treat. The study is registered as an International Standard Randomised Controlled Trial, number ISRCTN31137309.Findings From 2001 to 2003, the neonatal mortality rate was 26.2 per 1000 (76 deaths per 2899 livebirths) in intervention clusters compared with 36.9 per 1000 (119 deaths per 3226 livebirths) in controls (adjusted odds ratio 0 . 70 [95% CI 0 . 53-0.94]). Stillbirth rates were similar in both groups. The maternal mortality ratio was 69 per 100000 (two deaths per 2899 livebirths) in intervention clusters compared with 341 per 100000 (11 deaths per 3226 livebirths) in control clusters (0.22 [0.05-0.90]). Women in intervention clusters were more likely to have antenatal care, institutional delivery, trained birth attendance, and hygienic care than were controls.Interpretation Birth outcomes in a poor rural population improved greatly through a low cost, potentially sustainable and scalable, participatory intervention with women's groups.