Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial
- PMID: 20207411
- DOI: 10.1016/S0140-6736(09)62042-0
Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial
Abstract
Background: Community mobilisation through participatory women's groups might improve birth outcomes in poor rural communities. We therefore assessed this approach in a largely tribal and rural population in three districts in eastern India.
Methods: From 36 clusters in Jharkhand and Orissa, with an estimated population of 228 186, we assigned 18 clusters to intervention or control using stratified randomisation. Women were eligible to participate if they were aged 15-49 years, residing in the project area, and had given birth during the study. In intervention clusters, a facilitator convened 13 groups every month to support participatory action and learning for women, and facilitated the development and implementation of strategies to address maternal and newborn health problems. The primary outcomes were reductions in neonatal mortality rate (NMR) and maternal depression scores. Analysis was by intention to treat. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN21817853.
Findings: After baseline surveillance of 4692 births, we monitored outcomes for 19 030 births during 3 years (2005-08). NMRs per 1000 were 55.6, 37.1, and 36.3 during the first, second, and third years, respectively, in intervention clusters, and 53.4, 59.6, and 64.3, respectively, in control clusters. NMR was 32% lower in intervention clusters adjusted for clustering, stratification, and baseline differences (odds ratio 0.68, 95% CI 0.59-0.78) during the 3 years, and 45% lower in years 2 and 3 (0.55, 0.46-0.66). Although we did not note a significant effect on maternal depression overall, reduction in moderate depression was 57% in year 3 (0.43, 0.23-0.80).
Interpretation: This intervention could be used with or as a potential alternative to health-worker-led interventions, and presents new opportunities for policy makers to improve maternal and newborn health outcomes in poor populations.
Funding: Health Foundation, UK Department for International Development, Wellcome Trust, and the Big Lottery Fund (UK).
Copyright 2010 Elsevier Ltd. All rights reserved.
Similar articles
-
Effect of scaling up women's groups on birth outcomes in three rural districts in Bangladesh: a cluster-randomised controlled trial.Lancet. 2010 Apr 3;375(9721):1193-202. doi: 10.1016/S0140-6736(10)60142-0. Epub 2010 Mar 6. Lancet. 2010. PMID: 20207412 Clinical Trial.
-
Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster-randomised controlled trial.Lancet Glob Health. 2016 Feb;4(2):e119-28. doi: 10.1016/S2214-109X(15)00287-9. Lancet Glob Health. 2016. PMID: 26823213 Clinical Trial.
-
Effect of participatory women's groups and counselling through home visits on children's linear growth in rural eastern India (CARING trial): a cluster-randomised controlled trial.Lancet Glob Health. 2017 Oct;5(10):e1004-e1016. doi: 10.1016/S2214-109X(17)30339-X. Lancet Glob Health. 2017. PMID: 28911749 Free PMC article. Clinical Trial.
-
Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis.Lancet. 2013 May 18;381(9879):1736-46. doi: 10.1016/S0140-6736(13)60685-6. Lancet. 2013. PMID: 23683640 Free PMC article. Review.
-
Oxytocin for preventing postpartum haemorrhage (PPH) in non-facility birth settings.Cochrane Database Syst Rev. 2016 Apr 14;4(4):CD011491. doi: 10.1002/14651858.CD011491.pub2. Cochrane Database Syst Rev. 2016. PMID: 27078125 Free PMC article. Review.
Cited by 216 articles
-
If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia.BMJ Glob Health. 2021 Dec;6(12):e006385. doi: 10.1136/bmjgh-2021-006385. BMJ Glob Health. 2021. PMID: 34876457 Free PMC article.
-
Sense of Coherence, Social Support, Maternal-Fetal Attachment, and Antenatal Mental Health: A Survey of Expecting Mothers in Urban India.Front Glob Womens Health. 2021 Sep 7;2:714182. doi: 10.3389/fgwh.2021.714182. eCollection 2021. Front Glob Womens Health. 2021. PMID: 34816240 Free PMC article.
-
Layering of a health, nutrition and sanitation programme onto microfinance-oriented self-help groups in rural India: results from a process evaluation.BMC Public Health. 2021 Nov 20;21(1):2131. doi: 10.1186/s12889-021-12049-0. BMC Public Health. 2021. PMID: 34801003 Free PMC article.
-
Effectiveness of participatory women's groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial.BMJ Glob Health. 2021 Nov;6(11):e005066. doi: 10.1136/bmjgh-2021-005066. BMJ Glob Health. 2021. PMID: 34732513 Free PMC article. Clinical Trial.
-
Exploring change over time in community mobilization domains: results from a maternity waiting home intervention in rural Zambia.Int J Equity Health. 2021 Oct 19;20(1):228. doi: 10.1186/s12939-021-01557-5. Int J Equity Health. 2021. PMID: 34666762 Free PMC article.