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An Intervention to Enhance Obstetric and Newborn Care in India: A Cluster Randomized-Trial

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Abstract

Objectives

This study assessed whether community mobilization and interventions to improve emergency obstetric and newborn care reduced perinatal mortality (PMR) and neonatal mortality rates (NMR) in Belgaum, India.

Methods

The cluster-randomised controlled trial was conducted in Belgaum District, Karnataka State, India. Twenty geographic clusters were randomized to control or the intervention. The intervention engaged and mobilized community and health authorities to leverage support; strengthened community-based stabilization, referral, and transportation; and aimed to improve quality of care at facilities.

Results

17,754 Intervention births and 15,954 control births weighing ≥1000 g, respectively, were enrolled and analysed. Comparing the baseline period to the last 6 months period, the NMR was lower in the intervention versus control clusters (OR 0.60, 95 % CI 0.34–1.06, p = 0.076) as was the PMR (OR 0.74, 95 % CI 0.46–1.19, p = 0.20) although neither reached statistical significance. Rates of facility birth and caesarean section increased among both groups. There was limited influence on quality of care measures.

Conclusions for Practice

The intervention had large but not statistically significant effects on neonatal and perinatal mortality. Community mobilization and increased facility care may ultimately improve neonatal and perinatal survival, and are important in the context of the global transition towards institutional delivery.

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Acknowledgments

This study was funded through grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Women’s and Children’s Health Research Unit, KLE University’s Jawaharlal Nehru Medical College, Belgaum, India

    Shivaprasad S. Goudar, Narayan V. Honnungar, Kamal P. Patil, Mallaiah K. Swamy & Bhalchandra S. Kodkany

  2. Department of Obstetrics and Gynaecology, Christiana Care Health Services, Newark, DE, USA

    Richard J. Derman & Nancy L. Sloan

  3. Social, Statistical, and Environmental Health Sciences, Research Triangle Institute, Research Triangle Park, Durham, NC, 27709, USA

    Janet Moore, Dennis D. Wallace & Elizabeth M. McClure

  4. Aga Khan University, Karachi, Pakistan

    Omrana Pasha

  5. Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA

    Linda L. Wright

  6. Department of Obstetrics and Gynaecology, Columbia University, New York, NY, USA

    Robert L. Goldenberg

Authors
  1. Shivaprasad S. Goudar
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  2. Richard J. Derman
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  3. Narayan V. Honnungar
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  4. Kamal P. Patil
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  5. Mallaiah K. Swamy
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  6. Janet Moore
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  7. Dennis D. Wallace
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  8. Elizabeth M. McClure
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  9. Bhalchandra S. Kodkany
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  10. Omrana Pasha
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  11. Nancy L. Sloan
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  12. Linda L. Wright
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  13. Robert L. Goldenberg
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Corresponding author

Correspondence to Elizabeth M. McClure.

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Goudar, S.S., Derman, R.J., Honnungar, N.V. et al. An Intervention to Enhance Obstetric and Newborn Care in India: A Cluster Randomized-Trial. Matern Child Health J 19, 2698–2706 (2015). https://doi.org/10.1007/s10995-015-1792-0

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  • DOI: https://doi.org/10.1007/s10995-015-1792-0

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