Community-driven impact of a newborn-focused behavioral intervention on maternal health in Shivgarh, India

Kumar, Vishwajeet; Kumar, Aarti; Das, Vinita; Srivastava, Neeraj M.; Baqui, Abdullah H.; Santosham, Mathuram; Darmstadt, Gary L.; for the Saksham Study Group,

doi:10.1016/j.ijgo.2011.10.031

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Community-driven impact of a newborn-focused behavioral intervention on maternal health in Shivgarh, India

Vishwajeet Kumar
- Community Empowerment Lab, Shivgarh, India
Aarti Kumar
- Community Empowerment Lab, Shivgarh, India
Vinita Das
- Department of Obstetrics and Gynecology, CSM Medical University, Lucknow, India
Neeraj M. Srivastava
- Community Empowerment Lab, Shivgarh, India
Abdullah H. Baqui
- International Center for Maternal and Neonatal Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
Mathuram Santosham
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
Gary L. Darmstadt
- International Center for Maternal and Neonatal Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
- Corresponding author at: Family Health Division, Global Health Program, Bill & Melinda Gates Foundation, PO Box 23350, Seattle, WA 98102, USA. Tel.: +1 206 770 1897; fax: +1 206 494 7040.
for the Saksham Study Group
- Saksham Study Group: Ramesh C. Ahuja, Shally Awasthi, Abdullah H. Baqui, Mahendra Bhandari, Robert E. Black, Gary L. Darmstadt, Vinita Das, Aarti Kumar, Vishwajeet Kumar, Gyanendra K. Malik, Pragya Mishra, Rajendra P. Misra, Saroj Mohanty, Akanksha Rastogi, Mathuram Santosham, Sharleen Sidhu, Jai V. Singh, Pramod Singh, Vivek Singh, Neeraj M. Srivastava, Ranjanaa Yadav.

Received 7 July 2011; received in revised form 27 October 2011; accepted 13 December 2011. published online 27 January 2012.
Corrected Proof

Abstract

Objective

To assess the effect on maternal health outcomes of a community-based behavior change management intervention for essential newborn care leading to a reduction in neonatal mortality.

Methods

A cluster-randomized controlled trial involving 1 control and 2 intervention arms was conducted in Shivgarh, India, between January 2004 and May 2005. Risk-enhancing domiciliary newborn care behaviors, including those posing a concomitant risk to maternal health, were targeted through home visits and community meetings. Secondary outcomes included knowledge of maternal danger signs, self-reported complications, maternal care practices, care-seeking from trained providers, and maternal mortality ratio (MMR). The intervention arms were combined for analysis, which was done by intention to treat.

Results

Significant improvements were observed in maternal health equity and outcomes including knowledge of danger signs, care practices, self-reported complications, and timely care-seeking from trained providers. The difference in adjusted MMR was not significant (relative risk 0.44; 95% confidence interval, 0.14–1.43; P=0.11) owing to the inadequate sample size for this outcome, but may suggest a decline in MMR given improvements in other outcomes in the causal pathway to mortality.

Conclusion

Community-based strategies focused on prevention and care-seeking effectively complemented facility-based strategies toward improving maternal health, while synergizing with newborn care interventions.

Keywords: Behavior change management, Care-seeking, Essential newborn care, Equity, India, Maternal health