title: Maternal and Newborn Health in Karnataka State, India: The Community Level Interventions for Pre-Eclampsia (CLIP) Trial's Baseline Study Results.
abstract: Existing vital health statistics registries in India have been unable to provide reliable estimates of maternal and newborn mortality and morbidity, and region-specific health estimates are essential to the planning and monitoring of health interventions. This study was designed to assess baseline rates as the precursor to a community-based cluster randomized control trial (cRCT)-Community Level Interventions for Pre-eclampsia (CLIP) Trial (NCT01911494; CTRI/2014/01/004352). The objective was to describe baseline demographics and health outcomes prior to initiation of the CLIP trial and to improve knowledge of population-level health, in particular of maternal and neonatal outcomes related to hypertensive disorders of pregnancy, in northern districts the state of Karnataka, India. The prospective population-based survey was conducted in eight clusters in Belgaum and Bagalkot districts in Karnataka State from 2013-2014. Data collection was undertaken by adapting the Maternal and Newborn Health registry platform, developed by the Global Network for Women's and Child Health Studies. Descriptive statistics were completed using SAS and R. During the period of 2013-2014, prospective data was collected on 5,469 pregnant women with an average age of 23.2 (+/-3.3) years. Delivery outcomes were collected from 5,448 completed pregnancies. A majority of the women reported institutional deliveries (96.0%), largely attended by skilled birth attendants. The maternal mortality ratio of 103 (per 100,000 livebirths) was observed during this study, neonatal mortality ratio was 25 per 1,000 livebirths, and perinatal mortality ratio was 50 per 1,000 livebirths. Despite a high number of institutional deliveries, rates of stillbirth were 2.86%. Early enrollment and close follow-up and monitoring procedures established by the Maternal and Newborn Health registry allowed for negligible lost to follow-up. This population-level study provides regional rates of maternal and newborn health in Belgaum and Bagalkot in Karnataka over 2013-14. The mortality ratios and morbidity information can be used in planning interventions and monitoring indicators of effectiveness to inform policy and practice. Comprehensive regional epidemiologic data, such as that provided here, is essential to gauge improvements and challenges in maternal health, as well as track disparities found in rural areas.
authors.affiliation: Women's and Children's Health Research Unit, KLE's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Mrutynjaya B
authors.initials: MB
authors.lastname: Bellad
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Women's and Children's Health Research Unit, KLE's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Narayan V
authors.initials: NV
authors.lastname: Honnungar
authors.affiliation: S Nijalingappa Medical College, Balgalkot, Karnataka, India.
authors.forename: Ashalata
authors.initials: A
authors.lastname: Mallapur
authors.affiliation: S Nijalingappa Medical College, Balgalkot, Karnataka, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Ramadurg
authors.affiliation: Women's and Children's Health Research Unit, KLE's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Umesh
authors.initials: U
authors.lastname: Charanthimath
authors.affiliation: S Nijalingappa Medical College, Balgalkot, Karnataka, India.
authors.forename: Geetanjali
authors.initials: G
authors.lastname: Katageri
authors.affiliation: Women's and Children's Health Research Unit, KLE's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Shashidhar
authors.initials: S
authors.lastname: Bannale
authors.affiliation: Women's and Children's Health Research Unit, KLE's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Avinash
authors.initials: A
authors.lastname: Kavi
authors.affiliation: Women's and Children's Health Research Unit, KLE's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Chandrashekhar
authors.initials: C
authors.lastname: Karadiguddi
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Sumedha
authors.identifier: 0000-0002-3267-2720
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Tang
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Beth
authors.initials: B
authors.lastname: Payne
authors.affiliation: Molecular and Clinical Sciences Research Institute, St George's, University of London and Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Laura
authors.initials: L
authors.lastname: Magee
authors.affiliation: Molecular and Clinical Sciences Research Institute, St George's, University of London and Department of Obstetrics and Gynaecology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Department Obstetrics and Gynaecology and Global Health Research Thomas Jefferson University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Richard
authors.initials: R
authors.lastname: Derman
authors.affiliation: Women's and Children's Health Research Unit, KLE's Jawaharlal Nehru Medical College, Belgaum, Karnataka, India.
authors.forename: Shivaprasad S
authors.initials: SS
authors.lastname: Goudar
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D000068104:Infant Health; D007226:Infant Mortality; D007231:Infant, Newborn; D000068097:Maternal Health; D008428:Maternal Mortality; D010342:Patient Acceptance of Health Care; D011225:Pre-Eclampsia / Q000628:therapy*; D011247:Pregnancy; D011446:Prospective Studies; D055815:Young Adult