title: Nurse-based antenatal and child health care in rural India, implementation and effects - an Indian-Swedish collaboration.
abstract: BACKGROUND
  Improving maternal and child health care are two of the Millennium Development Goals of the World Health Organization. India is one of the countries worldwide most burdened by maternal and child deaths. The aim of the study was to describe how families participate in nurse-based antenatal and child health care, and the effect of this in relation to referrals to specialist care, institutional deliveries and mortality.
  
  
  METHODS
  The intervention took place in a remote rural area in India and was influenced by Swedish nurse-based health care. A baseline survey was performed before the intervention commenced. The intervention included education program for staff members with a model called Training of Trainers and the establishment of clinics as both primary health centers and mobile clinics. Health records and manuals, and informational and educational materials were produced and the clinics were equipped with easily handled instruments. The study period was between 2006 and 2009. Data were collected from antenatal care and child healthcare records. The Chi-square test was used to analyze mortality differences between years. A focus group discussion and a content analysis were performed.
  
  
  RESULTS
  Families' participation increased which led to more check-ups of pregnant women and small children. Antenatal visits before 16 weeks among pregnant women increased from 32 to 62% during the period. Women having at least three check-ups during pregnancy increased from 30 to 60%. Maternal mortality decreased from 478 to 121 per 100 000 live births. The total numbers of children examined in the project increased from approximately 6000 to 18 500 children. Infant mortality decreased from 80 to 43 per 1000 live births. Women and children referred to specialist care increased considerably and institutional deliveries increased from 47 to 74%.
  
  
  CONCLUSIONS
  These results suggest that it is possible in a rural and remote area to influence peoples' awareness of the value of preventive health care. The results also indicate that this might decrease maternal and child mortality. The education led to a more patient-friendly encounter between health professionals and patients.
authors.affiliation: Division of Nursing Science, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden. siw.alehagen@liu.se
authors.forename: Siw A
authors.initials: SA
authors.lastname: Alehagen
authors.forename: Orvar
authors.initials: O
authors.lastname: Finnström
authors.forename: Göran V
authors.initials: GV
authors.lastname: Hermansson
authors.forename: Konduri V
authors.initials: KV
authors.lastname: Somasundaram
authors.forename: Vidyadhar B
authors.initials: VB
authors.lastname: Bangal
authors.forename: Ashok
authors.initials: A
authors.lastname: Patil
authors.forename: Pratibha
authors.initials: P
authors.lastname: Chandekar
authors.forename: Annakarin K
authors.initials: AK
authors.lastname: Johansson
mesh_terms: D000328:Adult; D002675:Child, Preschool; D003299:Cooperative Behavior; D005192:Family Health / Q000193:education; D005193:Family Planning Services; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation; D006801:Humans; D007194:India; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D007400:Interprofessional Relations; D008428:Maternal Mortality / Q000639:trends; D008430:Maternal-Child Health Centers / Q000592:standards / Q000706:statistics & numerical data; D009774:Obstetrics / Q000193:education / Q000592:standards; D009937:Organizational Objectives; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D057184:Practice Patterns, Nurses'; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011369:Professional-Patient Relations; D019035:Rural Health Services / Q000592:standards; D013548:Sweden; D000078329:Workforce