Newborn Health Problems Research Articles

Comparative Analysis on Safe Traditional Practices by Iraqi and Philippine Mothers in the Treatment of Newborn Health Problems: A Narrative Review

Background: Traditional practices are usually derived from the relationships with the environment and human attitude towards nature. Various societies, especially in developing nations, have unsafe traditional practices for newborns, traditionally associated with poverty, low educational levels, religiosity, culture, and by word of mouth intergenerationally handed over advice by elders in the families. Objectives: This narrative review points out the prevalence, cultural significance, and health implications of unsafe traditional newborn care practices in Iraq and the Philippines. Methods: Literature was searched in PubMed, Scopus, Web of Science, CINAHL, and Google. All iterations searched literature among mothers whose neonates were at issues, favoring traditional techniques rather than modern medicine—a total of 51 articles to be reviewed from articles published from 2019 to June 2024. Results: The following ten critical themes of unsafe practices were identified: care of the umbilical cord, feeding, traditional healing, bathing rituals, circumcision, swaddling, and treatments for gastrointestinal, respiratory, and eye problems, besides newborn isolation and practices of exposure. All these practices are comparatively prevalent in the rural setup and are ingrained in the fabric of cultural beliefs and traditions. These could include exposure to infection, complications, developmental delays, and neonatal mortality. The practices have also been associated with the perpetuation of poverty, low literacy levels, and cultural backgrounds. Conclusion: This review indicates that interventions towards these problems have to be multi-faceted. Multiple dimensions can be integrated into evidence-based interventions to improve education and economic opportunities, engagement with religious and cultural leaders, health system strengthening, fomenting research, and community engagement to develop culturally relevant solutions linking tradition and evidence-based care to improve newborn health outcomes.

A Study to Assess the Effectiveness of Planned Teaching Programme Regarding the Management of Selected Neonatal Health Problems among Mothers of Neonates in a Selected Hospital at Kolar District

Background: From birth to initial four weeks of life is known as Neonate. The term early neonatal phase describes fundamental week of life. While the late neonatal period refers to the time between 7 and 28 days of existence. Minor newborn health problems are the main cause of morbidity in several children. Particularly common in low birth weight and premature babies and these minor problems may be the indication of major underlying diseases. Methods : The main target of this research is to assess and compare the impact of organised teaching methods on selected minor neonatal health problems among the mother of neonates. The study was carried out at SNR District Hospital, Kolar. There are 60 mothers of neonates admitted in postpartum unit were chosen for the research. The Quantitative Pre experimental study design was employed for the investigation. Mothers of neonates (n=60) were admitted in postnatal ward at SNR district hospital, Kolar were picked up by convenient sampling method. Likelihood of the research clarification of that instrument was evaluated through pilot study. Pre-test was led by utilizing questionnaire method. Treatment then introduced as well as after seven days after testing was performed for the same group. Results : In this research, the investigator analyzed that the average mean percentile of the pre-test result was 27.16% with the mean (8.15) and standard deviation (2.18). The post-test average mean percentage was 77.86 % with mean (23.36) and standard deviation, too (2.33). Interpretation and conclusion: The research found that there is a remarkable advancement in relation to understanding of mothers of neonates after receiving the organised educational programme on management of neonatal health problems. Keywords: Neonates, Teaching, Effectiveness, Health problem

Better scan personalities than bodies? Prenatal care to enforce a pregnancy self-commitment

ABSTRACT The purpose of this work was to measure the effect of the proper prenatal medical care on the health of newborns. This study was based on a survey conducted in France in 2010 by the National Institute for Health and Medical Research and the Ministry of Health. Three different definitions of newborn health were used, and the definition of proper prenatal care was set based on the recommendations of the Haute Autorité de Santé (HAS). The analysis was conducted based on propensity score methods to adjust for potential confounders. The results showed that proper prenatal may reduce some newborn health problems. But, if allowance is made for women’s behaviour or for mothers’ perceptions of their pregnancy, prenatal care could have no effect on newborn health. Moreover, it seems that a subpopulation of women would use prenatal care visits to enforce a self-commitment, to adhere to personal good conduct rather than for only medical reasons. Better information, prevention and customization of prenatal care according to pregnant women’s profiles might be more effective in terms of health and perhaps cost-saving.

Postpartum depression among first-time Jordanian mothers: levels and associated factors

ABSTRACT Postpartum depression among first-time mothers is a sensitive issue and few studies were conducted related to this topic in developing countries including Jordan. Thus, this study purposed to assess postpartum depression levels and associated factors among Jordanian first-time mothers. A cross-sectional design was adopted, and 193 postpartum first-time mothers living in Amman governorate were recruited. A questionnaire consisting of two parts was used to record data, sociodemographic and maternal health, and Patient Health Questionnaire (PHQ-9). Findings showed that 34.1% of the women experienced postpartum depression. The employment, gravida, antenatal health problems, breastfeeding problems, newborn health problems, and availability of assistance during the postpartum period significantly correlated with postpartum depression. Thus, the understanding of postpartum depression and related factors would provide important empirical evidence for healthcare professionals and policy-makers when planning to develop strategies and measures to minimize postpartum depression among first-time mothers.

Practice of Essential Care for Newborns in the Referral Health Center of Commune 5 of Bamako District

Introduction: Delay in recognizing newborn health problems and delay in accessing quality care contribute to a high number of newborn deaths. The objective of this work was to study the practice of essential newborn care. Patients and method: This was a descriptive study on critical care newborns at the referral health Center of the Commune 5 (CSRéf C5) Bamako from 1st April to 31 May 2018. The acquisition, processing and data analysis were done on SPSS software. Results: The average age of the patients was 24.8 years. They were out of school and knew about the importance of prenatal consultations (83.3%). The majority of health workers were Nurses and Obstetricians (59.3%). The effective care (100%) given to the newborns was anthropometric measurements of the newborn and identification of the newborn. Treatments such as stimulated drying, skin-to-skin contact, warming, and administration of vitamin K1 were each administered at over 90%. The fight against heat loss by the head (14.1%) and early latching (41.5%) were insufficiently administered. Cord care was not provided at the Hospital prior to discharge for contextual reasons. The administration of ocular antiseptics was not administered in the hospital. Conclusion: The administration of essential newborn care at the referral health Center of the Commune 5 in Bamako has shortcomings.

Effectiveness of participatory women’s groups scaled up by the public health system to improve birth outcomes in Jharkhand, eastern India: a pragmatic cluster non-randomised controlled trial

IntroductionThe WHO recommends community mobilisation with women’s groups practising participatory learning and action (PLA) to improve neonatal survival in high-mortality settings. This intervention has not been evaluated at scale with...

Increased Nucleated RBCs in Cord Blood: Not an Exclusion Criterion but a Quality Indicator for Hematopoietic Progenitor Cell Transplantation.

Increased nucleated red blood cell (NRBC) counts have been reported to be associated with adverse fetal outcomes, and cord blood units (CBUs) with increased NRBC counts require a 2nd questionnaire to determine their suitability for transplantation. However, a recent study demonstrated a positive correlation of NRBCs with CD34+ cells and total nucleated cells (TNCs). We evaluated the association between the NRBC count and hematopoietic progenitor cell (HPC) content (TNC and CD34+ cell counts) in Korean full-term newborn CBUs. In addition, we assessed whether an increased NRBC count is associated with newborn health problems that impair CBU safety. Among the 32,876 units processed from May 2006 to December 2018, a total of 23,385 CBUs with a TNC count ≥ 7×108 and reliable perinatal information were analyzed to assess the association of the NRBC count with CBU parameters, and the newborns associated with 457 CBUs that required the 2nd questionnaire due to an increased NRBC (≥ 15 NRBCs/100 WBCs) were assessed at one year for health problems that threatened CBU safety. The majority of the CBUs that required the 2nd questionnaire due to an increased NRBC count (96.9%) were determined to be suitable for transplantation. Those with an increased NRBC count showed significantly higher CD34+ cell and TNC counts and a higher rate of transplantation (P < 0.001, < 0.001 and 0.025, respectively). NRBCs showed a significant positive correlation with TNCs and CD34+ cells and a significant negative correlation with birth weight (all P < 0.001; adjusted r=0.185, 0.369 and - 0.029, respectively). In the multiple linear regression analysis, NRBCs showed independent and positive correlations with TNCs and CD34+ cells after adjustments for birth weight and gestational age (all P < 0.001; β=0.182, adjusted R2=0.053 and β=0.367, adjusted R2=0.418). An increased NRBC count in full-term normal delivery is a surrogate marker of HPCs in CBUs rather than an exclusion criterion for CBU safety. Moreover, providing the NRBC count together with the NRBC-corrected TNC count will be useful for clinicians to select CBUs for transplantation.

Knowledge of neonatal danger signs and associated factors among mothers attending pediatric immunization clinics in Gidan District Health Centers, North Wollo, Ethiopia

BackgroundThe majority of neonatal deaths in developing countries occurred at home due to late recognition of the signs of serious illness by parents or caregivers. In Ethiopia, besides the attempts made to scale-up the maternal and child health services, maternal knowledge of neonatal danger signs is low. Therefore, this study aimed to assess the knowledge of neonatal danger signs and associated factors among mothers attending pediatric immunization clinics in Gidan district health centers, North Wollo, Ethiopia. MethodAn institution-based cross-sectional study was conducted from September 1–30, 2020, among 399 mothers attending pediatric immunization clinics in Gidan district health centers. The data were collected using a pretested, structured, and interviewer-administered questionnaire. Epidata version 4.4.2.0 was used for data entry, and Statistical Package for Social Sciences version 22 was used for analysis. Descriptive statistics, bivariate and multivariate logistic regression were computed. Finally, an adjusted odds ratio along with 95% CI was calculated, and variables that had a P-value <0.05 were declared statistically significant. ResultThe level of good maternal knowledge of neonatal danger signs in the study area was 48.1% (95% CI, 43.6%–52.9%). Maternal education level (AOR: 3.58, 95% CI, 1.22–10.55), parity (AOR: 2.10, 95% CI 1.18–3.71), having postnatal care follow-up (AOR: 2.05, 95% CI, 1.21–3.49), receiving health education about neonatal danger signs (AOR: 4.87, 95% CI, 2.73–8.68), and previous experience of neonatal danger signs (AOR: 2.35, 95% CI, 1.33–4.15) were significantly associated variables with the maternal knowledge of neonatal danger signs. ConclusionThis study revealed that maternal knowledge of neonatal danger signs was low. Maternal educational level, parity, postnatal care follow-up, health education about neonatal danger signs, and previous experience of neonatal danger signs were significantly associated variables. Therefore, maternal knowledge of neonatal danger signs needs to be enhanced through improving postnatal care services utilization and providing adequate health education about newborn health problems.

The Association Between Maternity Waiting Home Use and Maternal-Newborn Knowledge: Latent Class Analysis.

An exploratory latent class analysis (LCA) was performed assessing the association between maternity waiting home (MWH) use and maternal-newborn care knowledge. A two-group comparison design using a face-to-face interview (n = 250) was conducted to understand if MWH use was associated with greater maternal knowledge of newborn care. High levels of maternal knowledge of newborn care were associated with MWH use. Mothers with low levels of knowledge were less likely to use an MWH prior to delivery and more likely to have fewer pregnancies, attend less than four antenatal care (ANC) visits, and receive no education about newborn health problems during ANC. Nurses need to target younger, primigravida mothers attending fewer ANC visits with educational opportunities while advocating for expansion of health education at MWHs to potentiate long-term benefits for improved maternal-newborn health and delivery outcomes.

Assessing the Implementation of a Behavior Change Intervention: Process Evaluation of a Stepped-Wedge Cluster Randomized Controlled Trial for Newborn Health.

Maternal and under five-year-old mortality rates have reduced in the last two decades globally due to concerted effort, yet newborn deaths remain unacceptably prevalent. Behavior change is an important component of interventions to address newborn health problems in low-income countries. In Cambodia, maternal and newborn mortality has markedly decreased, and continued improvements will allow the country to achieve further reduction in newborn morbidity. The results of an implementation study of the Newborn Care and Infection Control Initiative using process evaluation are presented to provide insight into the trial implementation and context of the program that may have contributed to intervention results. The study utilized a mixed method process to explore the context, mechanisms, and implementation of intervention components: training of village health support group volunteers to provide home visits, training of midwives on infection prevention and control around the perinatal period, counseling on newborn care, and provision of training materials for counseling and intervention. Implementation was evaluated through quantitative and qualitative data collection including surveys, observation, semi-structured interviews, focus groups, and visual media. Descriptive statistics summarized the quantitative data and thematic analysis was used to explore the qualitative data. The evaluation identified several factors that might have influenced the outcomes of the trial: continuity of health center staff communication, timing and ability to complete home visits, and training quality. Additional support for parents in the perinatal period, preferably provided at the community level, will contribute to further improvement in health outcomes for newborns in this area. Researchers in this context should consider mechanisms to improve the coordination of health facility staff counseling while providing support and resources to ensure home visits to families with newborns are made on time. Attention to staffing, training, and quality of newborn health interventions is critical in planning for the scaling-up of newborn health programming.

Household food insecurity associated with gestacional and neonatal outcomes: a systematic review

BackgroundFood insecurity (FI) occurs when people lack secure access to sufficient amounts of safe and nutritious food. FI has been associated with negative effects on human health, including during the prenatal and neonatal periods. The objective of this study is to evaluate the consequences of FI for pregnant women’s and newborns’ health.MethodsA literature search was performed with three independent researchers based on the PRISMA guidelines; the search covered the period of November 2008 to July 2019 and was conducted in the following databases: the US National Library of Medicine at the National Institutes of Health (PubMed), Latin American and Caribbean Health Sciences (LILACS), Cochrane Library, Web of Science, Embase, Scopus and OpenGrey. The terms and descriptors were defined by consulting the Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) platforms and mainly included “food security”, “food insecurity”, “pregnancy” and “newborn”. The studies were selected through a title and abstract review and then a reading of the full text. The quality of the studies and the risk of bias were analysed based on the criteria defined in the “Joanna Briggs Institute Reviewers’ Manual” and by Guyatt and colleagues for interventional studies. The population, study design, FI measurement instruments, FI proportions, outcomes, confounders and results were extracted from the 37 studies that were selected according to the eligibility and quality criteria.ResultsFI ​​proportions ranged from 5.2 to 87%. Most studies were conducted with African populations (42.2%) and applied globally used scales to assess FI (56.7%); 27% of the studies adapted scales. There were wide variations in the instruments used to estimate FI. The main outcomes related to FI included stress, anxiety and depression during pregnancy, followed by dietary quality and dietary diversity. Associations of FI with birth defects, neonatal mortality and the early introduction of animal milk to the infant’s diet were also observed.ConclusionsIt is necessary to pay attention to the diversity of FI measurement instruments before FI results are compared. FI can be a risk factor for depression and stress during pregnancy, as well as for neonatal mortality, newborn health problems and breastfeeding interruption.Trial registrationThis systematic review was registered on PROSPERO (CRD42018109478).

Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster-randomised controlled trial.

A quarter of the world's neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country's government-approved Accredited Social Health Activists (ASHAs). We aimed to test the effect of participatory women's groups facilitated by ASHAs on birth outcomes, including neonatal mortality. In this cluster-randomised controlled trial of a community intervention to improve maternal and newborn health, we randomly assigned (1:1) geographical clusters in rural Jharkhand and Odisha, eastern India to intervention (participatory women's groups) or control (no women's groups). Study participants were women of reproductive age (15-49 years) who gave birth between Sept 1, 2009, and Dec 31, 2012. In the intervention group, ASHAs supported women's groups through a participatory learning and action meeting cycle. Groups discussed and prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies, and assessed their progress. We identified births, stillbirths, and neonatal deaths, and interviewed mothers 6 weeks after delivery. The primary outcome was neonatal mortality over a 2 year follow up. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN31567106. Between September, 2009, and December, 2012, we randomly assigned 30 clusters (estimated population 156 519) to intervention (15 clusters, estimated population n=82 702) or control (15 clusters, n=73 817). During the follow-up period (Jan 1, 2011, to Dec 31, 2012), we identified 3700 births in the intervention group and 3519 in the control group. One intervention cluster was lost to follow up. The neonatal mortality rate during this period was 30 per 1000 livebirths in the intervention group and 44 per 1000 livebirths in the control group (odds ratio [OR] 0.69, 95% CI 0·53-0·89). ASHAs can successfully reduce neonatal mortality through participatory meetings with women's groups. This is a scalable community-based approach to improving neonatal survival in rural, underserved areas of India. Big Lottery Fund (UK).

Women's Group Intervention Is Tied to Lower Neonatal Mortality In Rural Communities in India

An intervention involving participatory women's groups facilitated by government-approved social workers was associated with reduced neonatal mortality in rural communities in eastern India, according to a cluster-randomized controlled trial conducted between 2009 and 2012. (1) Compared with births to women living in control communities, those to women living in intervention communities had 31% lower odds of resulting in death of the infant within the first 28 days of life (odds ratio, 0.7). In addition, the odds of certain home care practices--e.g., birth attendant's using a safe delivery kit and placing the infant against the mother's skin within one hour of birth--were greater for births occurring in intervention communities than for those in control communities (odds ratios, 1.4-5.1). For the study, researchers chose 30 clusters--geographic areas with a population of about 5,000 individuals each--from five rural districts of the Jharkhand and Odisha states of eastern India. Half the clusters were randomly selected to receive an intervention, which was implemented in September 2010 and consisted of a series of women's group meetings led by village-based accredited social health activists (ASHAs)--female community health workers trained under India's National Rural Health Mission. ASHAs purposively invited pregnant women and new mothers to participate; however, the meetings were open to all local women. During meetings, women discussed maternal and newborn health problems, strategized about how to solve them, implemented the strategies and assessed their progress. Control clusters did not receive the group meeting intervention; however, in all clusters, the researchers met with village health sanitation and nutrition staff, and with government officials and hospital management to address issues relevant to maternal and newborn health. Data were collected for a baseline period consisting of the year before the intervention was implemented and for a two-year evaluation period beginning three months after implementation. Monitoring teams attempted to ascertain all births and deaths to women of reproductive age living in study clusters through reports from local key informants and through birth records. Researchers interviewed mothers about six weeks after a delivery to document pregnancy- and birth-related events and practices, and conducted verbal autopsies for deaths among infants and mothers. One intervention cluster was lost to follow-up and was dropped from analyses. Descriptive analyses were used to compare baseline characteristics across groups, and logistic regression analyses were conducted to assess whether the intervention was associated with various outcomes, primarily neonatal mortality (i.e., death of an infant in the first 28 days of life), as well as home care and care-seeking practices. During the baseline period, 3,244 women (1,635 from intervention clusters and 1,609 controls) experienced 3,304 births. Overall, the mean age of mothers was 24.7 years; 65% could not read, and 58% had not attended school. The socioeconomic characteristics of women were the same across groups, except a greater proportion of women in the control group than of those in the intervention group had a secondary or higher education (33% vs. …

An impact evaluation of the Safe Motherhood Promotion Project in Bangladesh: Evidence from Japanese aid-funded technical cooperation

This paper reports the findings from a quasi-experimental impact evaluation of the Safe Motherhood Promotion Project (SMPP) conducted in the Narsingdi district of Bangladesh. SMPP is a Japanese aid-funded technical cooperation project aimed at developing local capacities to tackle maternal and newborn health problems in rural areas. We assessed whether the project interventions, in particular, community-based activities under the Model Union approach, had a favorable impact on women's access to and knowledge of maternal health care during pregnancy and childbirth. The project comprises a package of interlinked interventions to facilitate safe motherhood practices at primary and secondary care levels. The primary-level activities focused on community mobilization through participatory approaches. The secondary-level activities aimed at strengthening organizational and personnel capacities for delivering emergency obstetric care (EmOC) at district and sub-district level hospitals. The project impact was estimated by difference-in-differences logistic regressions using two rounds of cross-sectional household survey data. The results showed that the project successfully increased the utilization of antenatal visits and postpartum EmOC services and also enhanced women's knowledge of danger signs during pregnancy and delivery. The project also reduced income inequalities in access to antenatal care. In contrast, we found no significant increase in the use of skilled birth attendants (SBA) in the project site. Nonetheless, community mobilization activities and the government's voucher scheme played a complementary role in promoting the use of SBA.

Stillbirths and newborn deaths in slum settlements in Mumbai, India: a prospective verbal autopsy study

BackgroundThree million babies are stillborn each year and 3.6 million die in the first month of life. In India, early neonatal deaths make up four-fifths of neonatal deaths and infant mortality three-quarters of under-five mortality. Information is scarce on cause-specific perinatal and neonatal mortality in urban settings in low-income countries. We conducted verbal autopsies for stillbirths and neonatal deaths in Mumbai slum settlements. Our objectives were to classify deaths according to international cause-specific criteria and to identify major causes of delay in seeking and receiving health care for maternal and newborn health problems.MethodsOver two years, 2005–2007, births and newborn deaths in 48 slum areas were identified prospectively by local informants. Verbal autopsies were collected by trained field researchers, cause of death was classified by clinicians, and family narratives were analysed to investigate delays on the pathway to mortality.ResultsOf 105 stillbirths, 65 were fresh (62%) and obstetric complications dominated the cause classification. Of 116 neonatal deaths, 87 were early and the major causes were intrapartum-related (28%), prematurity (23%), and severe infection (22%). Bereavement was associated with socioeconomic quintile, previous stillbirth, and number of antenatal care visits. We identified 201 individual delays in 121/187 birth narratives (65%). Overall, delays in receiving care after arrival at a health facility dominated and were mostly the result of referral from one institution to another. Most delays in seeking care were attributed to a failure to recognise symptoms of complications or their severity.ConclusionsIn Mumbai’s slum settlements, early neonatal deaths made up 75% of neonatal deaths and intrapartum-related complications were the greatest cause of mortality. Delays were identified in two-thirds of narratives, were predominantly related to the provision of care, and were often attributable to referrals between health providers. There is a need for clear protocols for care and transfer at each level of the health system, and an emphasis on rapid identification of problems and communication between health facilities.Trial registrationISRCTN96256793

Community mobilisation with women's groups facilitated by Accredited Social Health Activists (ASHAs) to improve maternal and newborn health in underserved areas of Jharkhand and Orissa: study protocol for a cluster-randomised controlled trial

BackgroundAround a quarter of the world's neonatal and maternal deaths occur in India. Morbidity and mortality are highest in rural areas and among the poorest wealth quintiles. Few interventions to improve maternal and newborn health outcomes with government-mandated community health workers have been rigorously evaluated at scale in this setting.The study aims to assess the impact of a community mobilisation intervention with women's groups facilitated by ASHAs to improve maternal and newborn health outcomes among rural tribal communities of Jharkhand and Orissa.Methods/designThe study is a cluster-randomised controlled trial and will be implemented in five districts, three in Jharkhand and two in Orissa. The unit of randomisation is a rural cluster of approximately 5000 population. We identified villages within rural, tribal areas of five districts, approached them for participation in the study and enrolled them into 30 clusters, with approximately 10 ASHAs per cluster. Within each district, 6 clusters were randomly allocated to receive the community intervention or to the control group, resulting in 15 intervention and 15 control clusters. Randomisation was carried out in the presence of local stakeholders who selected the cluster numbers and allocated them to intervention or control using a pre-generated random number sequence. The intervention is a participatory learning and action cycle where ASHAs support community women's groups through a four-phase process in which they identify and prioritise local maternal and newborn health problems, implement strategies to address these and evaluate the result. The cycle is designed to fit with the ASHAs' mandate to mobilise communities for health and to complement their other tasks, including increasing institutional delivery rates and providing home visits to mothers and newborns. The trial's primary endpoint is neonatal mortality during 24 months of intervention. Additional endpoints include home care practices and health care-seeking in the antenatal, delivery and postnatal period. The impact of the intervention will be measured through a prospective surveillance system implemented by the project team, through which mothers will be interviewed around six weeks after delivery. Cost data and qualitative data are collected for cost-effectiveness and process evaluations.Study registrationISRCTN: ISRCTN31567106

Effect of a participatory intervention with women's groups on birth outcomes and maternal depression in Jharkhand and Orissa, India: a cluster-randomised controlled trial

Community mobilisation through participatory women's groups might improve birth outcomes in poor rural communities. We therefore assessed this approach in a largely tribal and rural population in three districts in eastern India. From 36 clusters in Jharkhand and Orissa, with an estimated population of 228 186, we assigned 18 clusters to intervention or control using stratified randomisation. Women were eligible to participate if they were aged 15-49 years, residing in the project area, and had given birth during the study. In intervention clusters, a facilitator convened 13 groups every month to support participatory action and learning for women, and facilitated the development and implementation of strategies to address maternal and newborn health problems. The primary outcomes were reductions in neonatal mortality rate (NMR) and maternal depression scores. Analysis was by intention to treat. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN21817853. After baseline surveillance of 4692 births, we monitored outcomes for 19 030 births during 3 years (2005-08). NMRs per 1000 were 55.6, 37.1, and 36.3 during the first, second, and third years, respectively, in intervention clusters, and 53.4, 59.6, and 64.3, respectively, in control clusters. NMR was 32% lower in intervention clusters adjusted for clustering, stratification, and baseline differences (odds ratio 0.68, 95% CI 0.59-0.78) during the 3 years, and 45% lower in years 2 and 3 (0.55, 0.46-0.66). Although we did not note a significant effect on maternal depression overall, reduction in moderate depression was 57% in year 3 (0.43, 0.23-0.80). This intervention could be used with or as a potential alternative to health-worker-led interventions, and presents new opportunities for policy makers to improve maternal and newborn health outcomes in poor populations. Health Foundation, UK Department for International Development, Wellcome Trust, and the Big Lottery Fund (UK).