Abstract
SummaryBackgroundAround 105 million people in India will be living in informal settlements by 2017. We investigated the effects of local resource centres delivering integrated activities to improve women's and children's health in urban informal settlements.MethodsIn a cluster-randomised controlled trial in 40 clusters, each containing around 600 households, 20 were randomly allocated to have a resource centre (intervention group) and 20 no centre (control group). Community organisers in the intervention centres addressed maternal and neonatal health, child health and nutrition, reproductive health, and prevention of violence against women and children through home visits, group meetings, day care, community events, service provision, and liaison. The primary endpoints were met need for family planning in women aged 15–49 years, proportion of children aged 12–23 months fully immunised, and proportion of children younger than 5 years with anthropometric wasting. Census interviews with women aged 15–49 years were done before and 2 years after the intervention was implemented. The primary intention-to-treat analysis compared cluster allocation groups after the intervention. We also analysed the per-protocol population (all women with data from both censuses) and assessed cluster-level changes. This study is registered with ISRCTN, number ISRCTN56183183, and Clinical Trials Registry of India, number CTRI/2012/09/003004.Findings12 614 households were allocated to the intervention and 12 239 to control. Postintervention data were available for 8271 women and 5371 children younger than 5 years in the intervention group, and 7965 women and 5180 children in the control group. Met need for family planning was greater in the intervention clusters than in the control clusters (odds ratio [OR] 1·31, 95% CI 1·11–1·53). The proportions of fully immunised children were similar in the intervention and control groups in the intention-to-treat analysis (OR 1·30, 95% CI 0·84–2·01), but were greater in the intervention group when assessed per protocol (1·73, 1·05–2·86). Childhood wasting did not differ between groups (OR 0·92, 95% CI 0·75–1·12), although improvement was seen at the cluster level in the intervention group (p=0·020).InterpretationThis community resource model seems feasible and replicable and may be protocolised for expansion.FundingWellcome Trust, CRY, Cipla.
Highlights
More than 377 million people live in India’s 7933 urban areas,[1,2] of which 53 house more than 1 million people each
We found no completed or published trial of a model of provision of integrated health care for informal settlement populations, models with some similarities are operational in Delhi and Chennai in India and in Bangladesh
Added value of this study We showed that a community resource centre model for women’s and children’s health was feasible and potentially replicable and incurred low cost in informal settlements
Summary
More than 377 million people live in India’s 7933 urban areas,[1,2] of which 53 house more than 1 million people each. Two-thirds of census towns include informal settlements (slums)[3] that are characterised by overcrowding, insubstantial housing, insufficient water and sanitation, lack of tenure, and hazardous locations.[4,5] There will be around 105 million people living in informal settlements by 2017.2 India’s National Urban Health Mission aims to facilitate equitable access to quality health care through an improved public health system, partnerships, and community-based mechanisms. Three tiers of provision are envisaged: secondary and tertiary institutions, urban health centres, and community outreach to informal settlements and other vulnerable groups.[6] This structure frames a context of pluralistic health care. There are charitable institutions and a wealth of private care providers (from specialist hospitals to unqualified practitioners), the latter of which are responsible for around 75% of outpatient consultations.[8]
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