Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster-randomised controlled trial

Abstract

Big Lottery Fund (UK).

Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia

“…Importance of childbirth planning (out of 8)2·81 [0·08] vs 5·50 [0·06]−0.71[−1.3, −0.11]e. Overall knowledge (out of 36)11·60 [0·24] vs 22·33 [0·18]−1.02 [−2, −0.03]Tripathy 2010 [55]India2005 to 2008Cluster RCT18 clustersWomen of reproductive age (15–49 years)17,3351.Low2.Unclear3.Unclear4.Low5.Unclear6.Low7.UnclearOverall: UnclearWomen’s education groups plus health system improvementControl (health system improvement)Antenatal careAny0.97 [0.48, 1.97]**1.11 [0.99, 1.23]*1·60 (0·65–3·92)#>  3 visits0.68 [0.37, 1.24]**0.70 [0.57, 0.87] *Skilled birth attendantAny0.52 [0.37, 0.74]**0.70 [0.57, 0.87]*Formal provider0.59 [0.37, 0.94]*0.67 [0.46, 1.00]*Traditional birth assistant0.82 [0.43, 1.56]*0.88 [0.68, 1.13]*Delivery at health care facility(any)( N  = number of pregnant women for all outcomes)0.64 [0.39, 1.04]**0.71 [0.66, 0.75]***Maternal deaths 2 years0.82 [0.51, 1.33]* 3 years0.77 [0.53, 1.13]*MMR (over 3 years)(per 100,000 live births)517.5 vs 680.30.70 [0.46, 1.07]**Tripathy 2016 [56]India2009 to 2012Randomised Controlled Trial30 clustersWomen of reproductive age(15–49 years)71001.Low2.Unclear3.Unclear4.Low5.Unclear6.Low7.LowOverall: UnclearWomen’s education groups plus health system improvementControl (health system improvement)Antenatal CareAny0.82 [0.35, 1.92]**0.90 [0.75, 1.07]*0·63 [0·35–1·16]#1.17 [0.78, 1.77]*> = 3 visits(N = number of births)1.08 [0.58, 2.01]*1.16 [1.12, 1.20]**Delivery at health care facility1.23 [0.58, 2.60]**0.63 [0.25, 1.42]**Maternal deaths2 years(N = number of live births for all of the above ou...…”

Economic evaluation of participatory learning and action with women’s groups facilitated by Accredited Social Health Activists to improve birth outcomes in rural eastern India

“…15 clusters were randomly allocated to receive the PLA intervention (estimated population 82,702), and 15 clusters to a control arm (estimated population 73,817) [14] These districts were selected because about half of the population of these districts belong to Scheduled Tribe1 community. However, in the study population, around 70% of the population belong to Scheduled Tribe community that have very high maternal and neonatal mortalities compared to the state and national average [14]. …”

“…Also, in both the intervention and control clusters, Ekjut organised monthly meetings with the village health sanitation and nutrition committees (VHSNCs) about their rights and entitlements. The details of PLA meetings and VHSNC meetings are described elsewhere [14]. One intervention cluster (estimated population 6203) was lost to follow up and the trial results have been presented comparing 14 intervention clusters (estimated population 76,499) and 15 control clusters (estimated population 73,817) [14].…”

“…The details of PLA meetings and VHSNC meetings are described elsewhere [14]. One intervention cluster (estimated population 6203) was lost to follow up and the trial results have been presented comparing 14 intervention clusters (estimated population 76,499) and 15 control clusters (estimated population 73,817) [14]. The intervention reduced neonatal mortality by 31% (adjusted odds ratio [aOR] 0.69, 95% CI 0.53–0.89) during a 24 months’ intervention period (Jan 1, 2011, to Dec 31, 2012) [14].…”

“…Proportion of institutional delivery was also found to be high in the intervention area compared to the control area. Since, throughout the intervention, focus was given to the women from the most marginalised community defined as those belonging to scheduled tribe community, being in the first and second lowest asset quintiles and unable to read and write, it was found that reduction in neo-natal mortality was the most among the most marginalised communities [14]. …”