title: Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the Global Network's EmONC trial).
abstract: BACKGROUND
  Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes.
  
  
  METHODS
  We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality.
  
  
  CONCLUSIONS
  In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01073488.
authors.affiliation: Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. omrana.pasha@aku.edu
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.forename: Sarah
authors.initials: S
authors.lastname: Saleem
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.forename: Fernando
authors.initials: F
authors.lastname: Althabe
authors.forename: Archana
authors.initials: A
authors.lastname: Patel
authors.forename: Fabian
authors.initials: F
authors.lastname: Esamai
authors.forename: Ana
authors.initials: A
authors.lastname: Garces
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Manolo
authors.initials: M
authors.lastname: Mazariegos
authors.forename: Bhala
authors.initials: B
authors.lastname: Kodkany
authors.forename: Jose M
authors.initials: JM
authors.lastname: Belizan
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Hibberd
authors.forename: Waldemar A
authors.initials: WA
authors.lastname: Carlo
authors.forename: Edward A
authors.initials: EA
authors.lastname: Liechty
authors.forename: K Michael
authors.initials: KM
authors.lastname: Hambidge
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
authors.forename: Dennis
authors.initials: D
authors.lastname: Wallace
authors.forename: Lisa
authors.initials: L
authors.lastname: Howard-Grabman
authors.forename: Suzanne
authors.initials: S
authors.lastname: Stalls
authors.forename: Marion
authors.initials: M
authors.lastname: Koso-Thomas
authors.forename: Alan H
authors.initials: AH
authors.lastname: Jobe
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
mesh_terms: D002959:Civil Defense / Q000193:education; D002985:Clinical Protocols; D019058:Community Networks / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000379:methods*; D003906:Developing Countries; D004630:Emergencies; D005260:Female; D006268:Health Facilities / Q000592:standards; D006700:Home Childbirth / Q000193:education*; D006801:Humans; D007224:Infant Care; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000379:methods*; D008428:Maternal Mortality; D008505:Medical Staff, Hospital / Q000193:education*; D008880:Midwifery / Q000193:education*; D009774:Obstetrics / Q000193:education; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D011787:Quality of Health Care / Q000592:standards