title: Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster-randomised controlled trial.
abstract: BACKGROUND
  A quarter of the world's neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country's government-approved Accredited Social Health Activists (ASHAs). We aimed to test the effect of participatory women's groups facilitated by ASHAs on birth outcomes, including neonatal mortality.
  
  
  METHODS
  In this cluster-randomised controlled trial of a community intervention to improve maternal and newborn health, we randomly assigned (1:1) geographical clusters in rural Jharkhand and Odisha, eastern India to intervention (participatory women's groups) or control (no women's groups). Study participants were women of reproductive age (15-49 years) who gave birth between Sept 1, 2009, and Dec 31, 2012. In the intervention group, ASHAs supported women's groups through a participatory learning and action meeting cycle. Groups discussed and prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies, and assessed their progress. We identified births, stillbirths, and neonatal deaths, and interviewed mothers 6 weeks after delivery. The primary outcome was neonatal mortality over a 2 year follow up. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN31567106.
  
  
  RESULTS
  Between September, 2009, and December, 2012, we randomly assigned 30 clusters (estimated population 156 519) to intervention (15 clusters, estimated population n=82 702) or control (15 clusters, n=73 817). During the follow-up period (Jan 1, 2011, to Dec 31, 2012), we identified 3700 births in the intervention group and 3519 in the control group. One intervention cluster was lost to follow up. The neonatal mortality rate during this period was 30 per 1000 livebirths in the intervention group and 44 per 1000 livebirths in the control group (odds ratio [OR] 0.69, 95% CI 0·53-0·89).
  
  
  CONCLUSIONS
  ASHAs can successfully reduce neonatal mortality through participatory meetings with women's groups. This is a scalable community-based approach to improving neonatal survival in rural, underserved areas of India.
  
  
  BACKGROUND
  Big Lottery Fund (UK).
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Prasanta
authors.initials: P
authors.lastname: Tripathy
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Nirmala
authors.initials: N
authors.lastname: Nair
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sinha
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Shibanand
authors.initials: S
authors.lastname: Rath
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Raj Kumar
authors.initials: RK
authors.lastname: Gope
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Suchitra
authors.initials: S
authors.lastname: Rath
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Swati Sarbani
authors.initials: SS
authors.lastname: Roy
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Aparna
authors.initials: A
authors.lastname: Bajpai
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Singh
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Vikash
authors.initials: V
authors.lastname: Nath
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Sarfraz
authors.initials: S
authors.lastname: Ali
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Alok Kumar
authors.initials: AK
authors.lastname: Kundu
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Dibakar
authors.initials: D
authors.lastname: Choudhury
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Sanjib Kumar
authors.initials: SK
authors.lastname: Ghosh
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Rajendra
authors.initials: R
authors.lastname: Mahapatra
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Edward
authors.initials: E
authors.lastname: Fottrell
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands.
authors.forename: Tanja A J
authors.initials: TA
authors.lastname: Houweling
authors.affiliation: Institute for Global Health, University College London, London, UK. Electronic address: Audrey.prost@ucl.ac.uk.
authors.forename: Audrey
authors.initials: A
authors.lastname: Prost
mesh_terms: D000068:Accreditation; D000328:Adult; D003906:Developing Countries; D005260:Female; D006282:Health Personnel; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D000068104:Infant Health; D007226:Infant Mortality; D000068097:Maternal Health; D000068101:Maternal-Child Health Services; D016017:Odds Ratio; D066087:Perinatal Death; D011247:Pregnancy; D011256:Pregnancy Outcome; D012424:Rural Population; D050497:Stillbirth; D055815:Young Adult