Community support groups can reduce neonatal mortality, and lower
rates of maternal depression-provided that the population coverage is
wide enough and the programmes are appropriately designed. These are the
conclusions of two Articles, published Online First in The Lancet.
women's groups have shown promise in trials in Nepal, reducing neonatal
mortality by about one-third. To test this approach further, two
research teams undertook cluster-randomised controlled trials that were
led by Anthony Costello, University College London Centre for
International Health and Development, Institute of Child Health, London,
In the first Article, Prasanta Tripathy, Ekjut,
Chakradharpur, Jharkand, India and colleagues, assigned clusters in a
population of 228186 people in Jharkand and Orissa in eastern India to
either participating in women's groups focusing on the reduction of
maternal and newborn health problems, or not. They monitored 19030
births over 3 years, and found that neonatal mortality was 32% lower
overall, and 45% lower in years 2 and 3 for women who had been living in
areas where women's groups existed than for those who had not. Moderate
maternal depression had fallen by 57% by the third year.
authors say: "Women's groups led by peer facilitators reduced neonatal
mortality rates and moderate maternal depression at low cost in largely
tribal, rural populations of eastern India. The most likely mechanism of
mortality reduction was through improved hygiene and care practices."
conclude: "Participatory groups have the advantage of helping the
poorest, being scalable at low cost, and producing potentially
wide-ranging and long-lasting effects. By addressing critical
consciousness, groups have the potential to create improved capability
in communities to deal with the health and development difficulties
arising from poverty and social inequalities."
In a second
Article, Professor Kishwar Azad, Perinatal Care Project, Diabetic
Association of Bangladesh, Dhaka, Bangladesh, and colleagues monitored
neonatal mortality for 36113 births over 3 years in a population of
503163. As with Tripathy et al's study, the study population was divided
into clusters, some of which were assigned to support from women's
groups. The authors found that the community support made no difference
to neonatal mortality rates.
They say: "For participatory women's
groups to have a significant effect on neonatal mortality in rural
Bangladesh, detailed attention to programme design and contextual
factors, enhanced population coverage, and increased enrolment of newly
pregnant women might be needed."
They add: "Women's groups, if
scaled to an adequate coverage, have the potential to reach the poorest
people and bring about substantial health and non-health benefits.
Nonetheless, a women's group approach requires adequate human resources
support for community mobilisation and
Read the full articles
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