title: An Intervention to Enhance Obstetric and Newborn Care in India: A Cluster Randomized-Trial.
abstract: OBJECTIVE
  This study assessed whether community mobilization and interventions to improve emergency obstetric and newborn care reduced perinatal mortality (PMR) and neonatal mortality rates (NMR) in Belgaum, India.
  
  
  METHODS
  The cluster-randomised controlled trial was conducted in Belgaum District, Karnataka State, India. Twenty geographic clusters were randomized to control or the intervention. The intervention engaged and mobilized community and health authorities to leverage support; strengthened community-based stabilization, referral, and transportation; and aimed to improve quality of care at facilities.
  
  
  RESULTS
  17,754 Intervention births and 15,954 control births weighing ≥1000 g, respectively, were enrolled and analysed. Comparing the baseline period to the last 6 months period, the NMR was lower in the intervention versus control clusters (OR 0.60, 95% CI 0.34-1.06, p = 0.076) as was the PMR (OR 0.74, 95% CI 0.46-1.19, p = 0.20) although neither reached statistical significance. Rates of facility birth and caesarean section increased among both groups. There was limited influence on quality of care measures.
  
  
  CONCLUSIONS
  The intervention had large but not statistically significant effects on neonatal and perinatal mortality. Community mobilization and increased facility care may ultimately improve neonatal and perinatal survival, and are important in the context of the global transition towards institutional delivery.
authors.affiliation: Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, India.
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
authors.affiliation: Department of Obstetrics and Gynaecology, Christiana Care Health Services, Newark, DE, USA.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Derman
authors.affiliation: Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, India.
authors.forename: Narayan V
authors.initials: NV
authors.lastname: Honnungar
authors.affiliation: Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, India.
authors.forename: Kamal P
authors.initials: KP
authors.lastname: Patil
authors.affiliation: Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, India.
authors.forename: Mallaiah K
authors.initials: MK
authors.lastname: Swamy
authors.affiliation: Social, Statistical, and Environmental Health Sciences, Research Triangle Institute, Research Triangle Park, Durham, NC, 27709, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Moore
authors.affiliation: Social, Statistical, and Environmental Health Sciences, Research Triangle Institute, Research Triangle Park, Durham, NC, 27709, USA.
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Wallace
authors.affiliation: Social, Statistical, and Environmental Health Sciences, Research Triangle Institute, Research Triangle Park, Durham, NC, 27709, USA. mcclure@rti.org.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: McClure
authors.affiliation: Women's and Children's Health Research Unit, KLE University's Jawaharlal Nehru Medical College, Belgaum, India.
authors.forename: Bhalchandra S
authors.initials: BS
authors.lastname: Kodkany
authors.affiliation: Aga Khan University, Karachi, Pakistan.
authors.forename: Omrana
authors.initials: O
authors.lastname: Pasha
authors.affiliation: Department of Obstetrics and Gynaecology, Christiana Care Health Services, Newark, DE, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Sloan
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, USA.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wright
authors.affiliation: Department of Obstetrics and Gynaecology, Columbia University, New York, NY, USA.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Goldenberg
mesh_terms: D002662:Child Health Services / Q000592:standards*; D003906:Developing Countries; D005260:Female; D006801:Humans; D007194:India; D007223:Infant; D007226:Infant Mortality / Q000639:trends; D008427:Maternal Health Services / Q000592:standards*; D008428:Maternal Mortality / Q000639:trends; D011247:Pregnancy
keywords: Community mobilization; Emergency obstetric and newborn care; India; Neonatal mortality; Perinatal mortality; Quality of care