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


Tripathy, P; Nair, N; Barnett, S; Mahapatra, R; Borghi, J; Rath, S; Gope, R; Mahto, D; Sinha, R; Lakshminarayana, R; Patel, V; Pagel, C; Prost, A; Costello, A; (2010) 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. Lancet, 375 (9721). pp. 1182-1192. ISSN 0140-6736 DOI: https://doi.org/10.1016/S0140-6736(09)62042-0

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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 228186, 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 19030 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.

Item Type: Article
Keywords: community-health workers, nepal, care, Adolescent, Adult, Consumer Participation, Delivery, Obstetric, education, Depression, Postpartum, prevention & control, Developing Countries, Female, Health Education, Home Childbirth, Humans, India, epidemiology, Infant Mortality, Infant, Newborn, Maternal Mortality, Middle Aged, Pregnancy, Prenatal Care, Rural Population, Socioeconomic Factors, Women, Young Adult
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Public Health and Policy > Dept of Global Health and Development
Research Centre: Centre for Global Mental Health
Centre for Maternal, Reproductive and Child Health (MARCH)
Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 20207411
Web of Science ID: 276858200030
URI: http://researchonline.lshtm.ac.uk/id/eprint/3793

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