title: Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh.
abstract: BACKGROUND
  Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality.
  
  
  METHODS
  This study took advantage of an ongoing health and demographic surveillance system (HDSS) and a new Maternal, Neonatal and Child Health (MNCH) Project initiated in 2007 in Matlab, Bangladesh in half (intervention area) of the HDSS area. In the other half, women received usual care through the government health system (comparison area). The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006) and after (2008-2009) implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas.
  
  
  RESULTS
  Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78). The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018).
  
  
  CONCLUSIONS
  The continuum of care approach provided through the integration of service delivery modes decreased the perinatal mortality rate within a short period of time. Further testing of this model is warranted within the government health system in Bangladesh and other low-income countries.
authors.affiliation: Centre for Reproductive Health, Mohakhali, Dhaka 1212, Bangladesh. arahman@icddrb.org
authors.forename: Anisur
authors.initials: A
authors.lastname: Rahman
authors.forename: Allisyn
authors.initials: A
authors.lastname: Moran
authors.forename: Jesmin
authors.initials: J
authors.lastname: Pervin
authors.forename: Aminur
authors.initials: A
authors.lastname: Rahman
authors.forename: Monjur
authors.initials: M
authors.lastname: Rahman
authors.forename: Sharifa
authors.initials: S
authors.lastname: Yeasmin
authors.forename: Hosneara
authors.initials: H
authors.lastname: Begum
authors.forename: Harunor
authors.initials: H
authors.lastname: Rashid
authors.forename: Mohammad
authors.initials: M
authors.lastname: Yunus
authors.forename: Daniel
authors.initials: D
authors.lastname: Hruschka
authors.forename: Shams E
authors.initials: SE
authors.lastname: Arifeen
authors.forename: Peter K
authors.initials: PK
authors.lastname: Streatfield
authors.forename: Lynn
authors.initials: L
authors.lastname: Sibley
authors.forename: Abbas
authors.initials: A
authors.lastname: Bhuiya
authors.forename: Marge
authors.initials: M
authors.lastname: Koblinsky
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D005260:Female; D006801:Humans; D018743:Perinatal Care / Q000458:organization & administration* / Q000592:standards*; D054238:Perinatal Mortality / Q000639:trends*; D011159:Population Surveillance; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D015397:Program Evaluation; D055815:Young Adult