Abstract

BackgroundThe UN Millennium Development Goals call for substantial reductions in maternal and child mortality, to be achieved through reductions in morbidity and mortality during pregnancy, delivery, postpartum and early childhood. The MaiMwana Project aims to test community-based interventions that tackle maternal and child health problems through increasing awareness and local action.Methods/DesignThis study uses a two-by-two factorial cluster-randomised controlled trial design to test the impact of two interventions. The impact of a community mobilisation intervention run through women's groups, on home care, health care-seeking behaviours and maternal and infant mortality, will be tested. The impact of a volunteer-led infant feeding and care support intervention, on rates of exclusive breastfeeding, uptake of HIV-prevention services and infant mortality, will also be tested. The women's group intervention will employ local female facilitators to guide women's groups through a four-phase cycle of problem identification and prioritisation, strategy identification, implementation and evaluation. Meetings will be held monthly at village level. The infant feeding intervention will select local volunteers to provide advice and support for breastfeeding, birth preparedness, newborn care and immunisation. They will visit pregnant and new mothers in their homes five times during and after pregnancy.The unit of intervention allocation will be clusters of rural villages of 2500-4000 population. 48 clusters have been defined and randomly allocated to either women's groups only, infant feeding support only, both interventions, or no intervention. Study villages are surrounded by 'buffer areas' of non-study villages to reduce contamination between intervention and control areas. Outcome indicators will be measured through a demographic surveillance system. Primary outcomes will be maternal, infant, neonatal and perinatal mortality for the women's group intervention, and exclusive breastfeeding rates and infant mortality for the infant feeding intervention.Structured interviews will be conducted with mothers one-month and six-months after birth to collect detailed quantitative data on care practices and health-care-seeking. Further qualitative, quantitative and economic data will be collected for process and economic evaluations.Trial registrationISRCTN06477126

Highlights

  • The UN Millennium Development Goals call for substantial reductions in maternal and child mortality, to be achieved through reductions in morbidity and mortality during pregnancy, delivery, postpartum and early childhood

  • There has been less than satisfactory progress, especially in sub-Saharan Africa, towards the child and maternal mortality targets of Millennium Development Goals (MDGs) 4 and 5

  • In Madagascar, exclusive breastfeeding rates increased from 46% to 68% and in Ghana rates increased from 31% to 68%

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Summary

Objectives

To test the impact of an intervention using community mobilisation through women’s groups on: a) Care practices and health care seeking behaviour for mothers and infants. C) Maternal, infant, neonatal and perinatal mortality. To test the impact of an intervention delivering health education through volunteer peer counsellors on: a) Exclusive breastfeeding rates, other care practices and health care seeking behaviour. To document and evaluate the process and costs for potential replicability and sustainability

Methods/Design
Funding period
Waltensperger K
17. Rifkin S
21. Gillies P
24. Howard-Grabman L
36. Howard-Grabman L
Findings
41. Fauveau V
Full Text
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