title: Community mobilisation and health management committee strengthening to increase birth attendance by trained health workers in rural Makwanpur, Nepal: study protocol for a cluster randomised controlled trial.
abstract: BACKGROUND
  Birth attendance by trained health workers is low in rural Nepal. Local participation in improving health services and increased interaction between health systems and communities may stimulate demand for health services. Significant increases in birth attendance by trained health workers may be affected through community mobilisation by local women's groups and health management committee strengthening. We will test the effect of community mobilisation through women's groups, and health management committee strengthening, on institutional deliveries and home deliveries attended by trained health workers in Makwanpur District.
  
  
  METHODS
  Cluster randomised controlled trial involving 43 village development committee clusters. 21 clusters will receive the intervention and 22 clusters will serve as control areas. In intervention areas, Female Community Health Volunteers are supported in convening monthly women's groups. The groups work through an action research cycle in which they consider barriers to institutional delivery, plan and implement strategies to address these barriers with their communities, and evaluate their progress. Health management committees participate in three-day workshops that use appreciative inquiry methods to explore and plan ways to improve maternal and newborn health services. Follow-up meetings are conducted every three months to review progress. Primary outcomes are institutional deliveries and home deliveries conducted by trained health workers. Secondary outcome measures include uptake of antenatal and postnatal care, neonatal mortality and stillbirth rates, and maternal morbidity.
  
  
  BACKGROUND
  ISRCTN99834806.
authors: Centre for International Health and Development, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. j.morrison@ich.ucl.ac.uk
authors: Joanna
authors: J
authors: Morrison
authors: Kirti Man
authors: KM
authors: Tumbahangphe
authors: Bharat
authors: B
authors: Budhathoki
authors: Rishi
authors: R
authors: Neupane
authors: Aman
authors: A
authors: Sen
authors: Kunta
authors: K
authors: Dahal
authors: Rita
authors: R
authors: Thapa
authors: Reema
authors: R
authors: Manandhar
authors: Dharma
authors: D
authors: Manandhar
authors: Anthony
authors: A
authors: Costello
authors: David
authors: D
authors: Osrin
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