Trial reportInternational health2013
Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial.
Trial report in International health, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers, 24 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
88 citing papers in PubMed, 24 syntheses or guidelines pooled it, 132 citations in OpenAlex.
- Quality improvement in public-private partnerships in low- and middle-income countries: a systematic review.BMC health services research · 2024Pooled it
- Community-Based Knowledge Translation Strategies for Maternal, Neonatal, and Perinatal Outcomes: A Systematic Review of Quantitative and Qualitative Data.International journal of public health · 2023Pooled it
- How and why do women's groups (WGs) improve the quality of maternal and child health (MCH) care? A systematic review of the literature.BMJ open · 2022Pooled it
- Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation.The Cochrane database of systematic reviews · 2021Pooled it
- Participatory learning and action cycles with women's groups to prevent neonatal death in low-resource settings: A multi-country comparison of cost-effectiveness and affordability.Health policy and planning · 2021Pooled it
- Interventions to reduce preterm birth and stillbirth, and improve outcomes for babies born preterm in low- and middle-income countries: A systematic review.Journal of global health · 2021Pooled it
- How and under what circumstances do quality improvement collaboratives lead to better outcomes? A systematic review.Implementation science : IS · 2020Pooled it
- The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review.Implementation science : IS · 2020Pooled it
- Community-based maternal and newborn educational care packages for improving neonatal health and survival in low- and middle-income countries.The Cochrane database of systematic reviews · 2019Pooled it
- The equity impact of community women's groups to reduce neonatal mortality: a meta-analysis of four cluster randomized trials.International journal of epidemiology · 2019Pooled it
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- The role of Community Mobilization in maternal care provision for women in sub-Saharan Africa- A systematic review of studies using an experimental design.BMC pregnancy and childbirth · 2017Pooled it
- Community-based approaches for neonatal survival: meta-analyses of randomized trial data.Bulletin of the World Health Organization · 2017Pooled it
- Effective non-drug interventions for improving outcomes and quality of maternal health care in sub-Saharan Africa: a systematic review.Systematic reviews · 2016Pooled it
- Health system and community level interventions for improving antenatal care coverage and health outcomes.The Cochrane database of systematic reviews · 2015Pooled it
- Community-based intervention packages for reducing maternal and neonatal morbidity and mortality and improving neonatal outcomes.The Cochrane database of systematic reviews · 2015Pooled it
- Pooled it
- Interventions aimed at communities to inform and/or educate about early childhood vaccination.The Cochrane database of systematic reviews · 2014Pooled it
- Preconception care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health.Reproductive health · 2014Pooled it
28 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
18 authors at 8 institutions in 4 countries.
Funding
Abstract
backgroundMaternal, perinatal and neonatal mortality remains high in low-income countries. We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi.
methodsWe evaluated a rural participatory women's group community intervention (CI) and a quality improvement intervention at health centres (FI) via a two-by-two factorial cluster randomized controlled trial. Consenting pregnant women were followed-up to 2 months after birth using key informants. Primary outcomes were maternal, perinatal and neonatal mortality. Clusters were health centre catchment areas assigned using stratified computer-generated randomization. Following exclusions, including non-birthing facilities, 61 clusters were analysed: control (17 clusters, 4912 births), FI (15, 5335), CI (15, 5080) and FI + CI (14, 5249). This trial was registered as International Standard Randomised Controlled Trial [ISRCTN18073903]. Outcomes for 14,576 and 20,576 births were recorded during baseline (June 2007-September 2008) and intervention (October 2008-December 2010) periods.
resultsFor control, FI, CI and FI + CI clusters neonatal mortality rates were 34.0, 28.3, 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2, 55.1, 48.0 and 48.4 per 1000 births, during the intervention period. Adjusting for clustering and stratification, the neonatal mortality rate was 22% lower in FI + CI than control clusters (OR = 0.78, 95% CI 0.60-1.01), and the perinatal mortality rate was 16% lower in CI clusters (OR = 0.84, 95% CI 0.72-0.97). We did not observe any intervention effects on maternal mortality.
conclusionsDespite implementation problems, a combined community and facility approach using participatory women's groups and quality improvement at health centres reduced newborn mortality in rural Malawi.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.