title: Community-driven impact of a newborn-focused behavioral intervention on maternal health in Shivgarh, India.
abstract: OBJECTIVE
  To assess the effect on maternal health outcomes of a community-based behavior change management intervention for essential newborn care leading to a reduction in neonatal mortality.
  
  
  METHODS
  A cluster-randomized controlled trial involving 1 control and 2 intervention arms was conducted in Shivgarh, India, between January 2004 and May 2005. Risk-enhancing domiciliary newborn care behaviors, including those posing a concomitant risk to maternal health, were targeted through home visits and community meetings. Secondary outcomes included knowledge of maternal danger signs, self-reported complications, maternal care practices, care-seeking from trained providers, and maternal mortality ratio (MMR). The intervention arms were combined for analysis, which was done by intention to treat.
  
  
  RESULTS
  Significant improvements were observed in maternal health equity and outcomes including knowledge of danger signs, care practices, self-reported complications, and timely care-seeking from trained providers. The difference in adjusted MMR was not significant (relative risk 0.44; 95% confidence interval, 0.14-1.43; P=0.11) owing to the inadequate sample size for this outcome, but may suggest a decline in MMR given improvements in other outcomes in the causal pathway to mortality.
  
  
  CONCLUSIONS
  Community-based strategies focused on prevention and care-seeking effectively complemented facility-based strategies toward improving maternal health, while synergizing with newborn care interventions.
authors.affiliation: Community Empowerment Lab, Shivgarh, India.
authors.forename: Vishwajeet
authors.initials: V
authors.lastname: Kumar
authors.forename: Aarti
authors.initials: A
authors.lastname: Kumar
authors.forename: Vinita
authors.initials: V
authors.lastname: Das
authors.forename: Neeraj M
authors.initials: NM
authors.lastname: Srivastava
authors.forename: Abdullah H
authors.initials: AH
authors.lastname: Baqui
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: Gary L
authors.initials: GL
authors.lastname: Darmstadt
mesh_terms: D003150:Community Health Workers; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007194:India; D007224:Infant Care; D007231:Infant, Newborn; D008428:Maternal Mortality; D008429:Maternal Welfare; D007744:Obstetric Labor Complications / Q000401:mortality*; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D049590:Postpartum Period; D011247:Pregnancy; D011295:Prenatal Care; D011314:Preventive Health Services; D019035:Rural Health Services; D012424:Rural Population; D057566:Self Report; D012923:Social Class