title: Community interventions to reduce child mortality in Dhanusha, Nepal: study protocol for a cluster randomized controlled trial.
abstract: BACKGROUND
  Neonatal mortality remains high in rural Nepal. Previous work suggests that local women's groups can effect significant improvement through community mobilisation. The possibility of identification and management of newborn infections by community-based workers has also arisen.
  
  
  METHODS
  The objective of this trial is to evaluate the effects on newborn health of two community-based interventions involving Female Community Health Volunteers. MIRA Dhanusha community groups: a participatory intervention with women's groups. MIRA Dhanusha sepsis management: training of community volunteers in the recognition and management of neonatal sepsis.The study design is a cluster randomized controlled trial involving 60 village development committee clusters allocated 1:1 to two interventions in a factorial design. MIRA Dhanusha community groups: Female Community Health Volunteers (FCHVs) are supported in convening monthly women's groups. Nine groups per cluster (270 in total) work through two action research cycles in which they (i) identify local issues around maternity, newborn health and nutrition, (ii) prioritize key problems, (iii) develop strategies to address them, (iv) implement the strategies, and (v) evaluate their success. Cycle 1 focuses on maternal and newborn health and cycle 2 on nutrition in pregnancy and infancy and associated postpartum care practices. MIRA Dhanusha sepsis management: FCHVs are trained to care for vulnerable newborn infants. They (i) identify local births, (ii) identify low birth weight infants, (iii) identify possible newborn infection, (iv) manage the process of treatment with oral antibiotics and referral to a health facility to receive parenteral gentamicin, and (v) follow up infants and support families.
  
  
  METHODS
  neonatal mortality rates.
  
  
  RESULTS
  MIRA Dhanusha community group: stillbirth, infant and under-two mortality rates, care practices and health care seeking behaviour, maternal diet, breastfeeding and complementary feeding practices, maternal and under-2 anthropometric status. MIRA Dhanusha sepsis management: identification and treatment of neonatal sepsis by community health volunteers, infection-specific neonatal mortality.
authors.affiliation: Mother and Infant Research Activities (MIRA), GPO Box 921, Kathmandu, Nepal.
authors.forename: Bhim P
authors.initials: BP
authors.lastname: Shrestha
authors.forename: Bishnu
authors.initials: B
authors.lastname: Bhandari
authors.forename: Dharma S
authors.initials: DS
authors.lastname: Manandhar
authors.forename: David
authors.initials: D
authors.lastname: Osrin
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.forename: Naomi
authors.initials: N
authors.lastname: Saville
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001942:Breast Feeding; D016000:Cluster Analysis; D003153:Community Health Services; D003150:Community Health Workers; D019058:Community Networks; D055812:Community-Based Participatory Research; D003906:Developing Countries; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008427:Maternal Health Services; D008875:Middle Aged; D009390:Nepal; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena; D012107:Research Design; D018805:Sepsis / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D050497:Stillbirth; D014838:Volunteers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents