Community health and medical provision: impact on neonates (the CHAMPION trial)

Abstract

Background: The trial aims to evaluate whether neonatal mortality can be reduced through systemic changes to the provision and promotion of healthcare. Neonatal mortality rates in India are high compared to other low income countries, and there is a wide variation of rates across regions. There is evidence that relatively inexpensive interventions may be able to prevent up to 75% of these deaths. One area with a particularly high rate is Mahabubnagar District in Andhra Pradesh, where neonatal mortality is estimated to be in the region of 4-9%. The area suffers from a vicious cycle of both poor supply of and small demand for health care services. The trial will assess whether a package of interventions to facilitate systemic changes to the provision and promotion of healthcare may be able to substantially reduce neonatal mortality in this area and be costeffective. If successful, the trial is designed so that it should be possible to substantially scale up the project in regions with similarly high neonatal mortality throughout Andhra Pradesh and elsewhere.

The Support to Rural India's Public Education System (STRIPES) Trial: A Cluster Randomised Controlled Trial of Supplementary Teaching, Learning Material and Material Support

“…The trial was conducted in villages with a population of less than 2,500 people in the Nagarkurnool division in the state of Andhra Pradesh in India which were participating in the CHAMPION Trial [12]. All children living in these villages who were potentially eligible for the trial were listed in January 2008, before the randomisation for the Champion trial.…”

“…The consent process initially followed that for the CHAMPION Trial [12] and is described in the trial protocol [13]. Approval of the protocol was obtained from the Department of Education of the Government of Andhra Pradesh.…”

Protocol for a cluster randomised trial in Madhya Pradesh, India: community health promotion and medical provision and impact on neonates (CHAMPION2); and support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2)

“…mobile teams providing antenatal and postnatal care in the home or through fixed day health services), and provision of facility-based care (i.e. subsidised access to non-public health centres) [18]. The primary outcome of neonatal mortality was significantly lower in the intervention arm compared to the control arm (52 neonatal deaths per 1000 live births versus 69 deaths per 1000 live births), a reduction of 24% (relative risk 0.76; 95% CI 0.64 to 0.90; p = 0.0018).…”

Protocol for a cluster randomised trial in Madhya Pradesh, India: Community health promotion and medical provision and impact on neonates (CHAMPION2); and support to rural India’s public education system and impact on numeracy and literacy scores (STRIPES2)

“…mobile teams providing antenatal and postnatal care in the home or through fixed day health services), and provision of facility-based care (i.e. subsidised access to non-public health centres) [18]. The primary outcome of neonatal mortality was significantly lower in the intervention arm compared to the control arm (52 neonatal deaths per 1000 live births vs. 69 per 1000 live births), a reduction of 24% (Relative Risk 0.76; 95% CI 0.64 to 0.90; p=0.0018).…”

“…The primary outcome of neonatal mortality was significantly lower in the intervention arm compared to the control arm (52 neonatal deaths per 1000 live births vs. 69 per 1000 live births), a reduction of 24% (Relative Risk 0.76; 95% CI 0.64 to 0.90; p=0.0018). The authors concluded that the CHAMPION intervention was strongly justified in this setting, but the trial needed adaptation and further development for evaluation in other areas [18].…”