Implementing a community-based participatory intervention to improve essential newborn care in rural Nepal.
The persistence of high perinatal and neonatal mortality rates in many developing countries make efforts to improve perinatal care in the home and at local health facilities important public health concerns. We describe a study which aims to evaluate a community-level participatory intervention in rural Nepal. The effectiveness of community-based action research interventions with mothers and other key members of the community in improving perinatal health outcomes is being examined using a cluster randomized, controlled trial covering a population of 28,000 married women of reproductive age. The unit of randomization was the village development committee (VDC): 12 VDCs receive the intervention while 12 serve as controls. The key elements of the intervention are the activities of female facilitators, each of whom works in one VDC facilitating the activities of women's groups in addressing problems in pregnancy, childbirth and the newborn period. Each group moves through a participatory planning cycle of assessment, sharing experiences, planning, action and reassessment, with the aim of improving essential maternal and newborn care. Outcomes assessed are neonatal and perinatal mortality rates, changes in patterns of home care, health care seeking and referral. The study also aims to generate programmatic information on the process of implementation in communities.
Osrin
David
D
Centre for International Child Health, Institute of Child Health, London, WC1N 1EH, UK. davido@wlink.com.np
Mesko
Natasha
N
Shrestha
Bhim P
BP
Shrestha
Dej
D
Tamang
Suresh
S
Thapa
Sushma
S
Tumbahangphe
Kirti M
KM
Shrestha
Jyoti R
JR
Manandhar
Madan K
MK
Manandhar
Dharma S
DS
Standing
Hilary
H
Costello
Anthony M
AM
D000293:Adolescent; D000328:Adult; D002648:Child; D002669:Child Welfare; D016000:Cluster Analysis; D003153:Community Health Services / Q000592:standards*; D005260:Female; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000592:standards*; D007226:Infant Mortality; D007231:Infant, Newborn; D008429:Maternal Welfare; D009390:Nepal; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000592:standards; D011247:Pregnancy; D011379:Prognosis; D012307:Risk Factors; D019035:Rural Health Services / Q000592:standards