title: The effect of increased coverage of participatory women's groups on neonatal mortality in Bangladesh: A cluster randomized trial.
abstract: OBJECTIVE
  Community-based interventions can reduce neonatal mortality when health systems are weak. Population coverage of target groups may be an important determinant of their effect on behavior and mortality. A women's group trial at coverage of 1 group per 1414 population in rural Bangladesh showed no effect on neonatal mortality, despite a similar intervention having a significant effect on neonatal and maternal death in comparable settings.
  
  
  OBJECTIVE
  To assess the effect of a participatory women's group intervention with higher population coverage on neonatal mortality in Bangladesh.
  
  
  METHODS
  A cluster randomized controlled trial in 9 intervention and 9 control clusters.
  
  
  METHODS
  Rural Bangladesh.
  
  
  METHODS
  Women permanently residing in 18 unions in 3 districts and accounting for 19 301 births during the final 24 months of the intervention.
  
  
  METHODS
  Women's groups at a coverage of 1 per 309 population that proceed through a participatory learning and action cycle in which they prioritize issues that affected maternal and neonatal health and design and implement strategies to address these issues.
  
  
  METHODS
  Neonatal mortality rate.
  
  
  RESULTS
  Analysis included 19 301 births during the final 24 months of the intervention. More than one-third of newly pregnant women joined the groups. The neonatal mortality rate was significantly lower in the intervention arm (21.3 neonatal deaths per 1000 live births vs 30.1 per 1000 in control areas), a reduction in neonatal mortality of 38% (risk ratio, 0.62 [95% CI, 0.43-0.89]) when adjusted for socioeconomic factors. The cost-effectiveness was US $220 to $393 per year of life lost averted. Cause-specific mortality rates suggest reduced deaths due to infections and those associated with prematurity/low birth weight. Improvements were seen in hygienic home delivery practices, newborn thermal care, and breastfeeding practices.
  
  
  CONCLUSIONS
  Women's group community mobilization, delivered at adequate population coverage, is a highly cost-effective approach to improve newborn survival and health behavior indicators in rural Bangladesh.
  
  
  BACKGROUND
  isrctn.org Identifier: ISRCTN01805825.
authors.affiliation: Institute for Global Health, University College London, England.
authors.forename: Edward
authors.initials: E
authors.lastname: Fottrell
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
authors.forename: Abdul
authors.initials: A
authors.lastname: Kuddus
authors.forename: Layla
authors.initials: L
authors.lastname: Younes
authors.forename: Sanjit
authors.initials: S
authors.lastname: Shaha
authors.forename: Tasmin
authors.initials: T
authors.lastname: Nahar
authors.forename: Bedowra Haq
authors.initials: BH
authors.lastname: Aumon
authors.forename: Munir
authors.initials: M
authors.lastname: Hossen
authors.forename: James
authors.initials: J
authors.lastname: Beard
authors.forename: Tanvir
authors.initials: T
authors.lastname: Hossain
authors.forename: Anni-Maria
authors.initials: AM
authors.lastname: Pulkki-Brannstrom
authors.forename: Jolene
authors.initials: J
authors.lastname: Skordis-Worrall
authors.forename: Audrey
authors.initials: A
authors.lastname: Prost
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.forename: Tanja A J
authors.initials: TA
authors.lastname: Houweling
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D001499:Bayes Theorem; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000458:organization & administration*; D015233:Models, Statistical; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D012044:Regression Analysis; D019035:Rural Health Services / Q000458:organization & administration*; D014930:Women; D055815:Young Adult