Urban Slum Community Research Articles

Factors associated with low birth weight among newborns in an urban slum community in Bhopal

A community based cohort study on birth weight of newborns was conducted among pregnant women of an urban slum in Bhupal, India. The study was carried out to assess the magnitude of low birth weight (LBW) and factors contributing it in an urban slum community. Socio-demographic and maternal characteristics were examined applying statistical techniques to find out the variables associated with the LBW. An additional schedule was used to collect information from mothers about their socio-demographic background, dietary intake and the rest during the pregnancy. Weight of newborns of mothers registered in the study and delivering at the district hospital was recorded. Mean birth weight of newborns of 290 registered mothers was 2.57 ± 0.36 g. One hundred and five newborns (36.2%) had a birth weight lesser than 2500 g. Among different variables studied, statistically significant association was found in case of occupation, daily calorie intake and duration of day-time rest taken by pregnant women.

Knowledge, Attitudes, and Practices Related to Leptospirosis among Urban Slum Residents in Brazil

Leptospirosis disproportionately affects residents of urban slums. To understand the knowledge, attitudes, and practices regarding leptospirosis, we conducted a cross-sectional study among residents of an urban slum community in Salvador, Brazil. Of the 257 residents who were interviewed, 225 (90%) were aware of leptospirosis and more than two-thirds of respondents correctly identified the modes of disease transmission and ways to reduce exposure. However, study participants who performed risk activities such as cleaning open sewers had limited access to protective clothing such as boots (33%) or gloves (35%). Almost all respondents performed at least one activity to prevent household rat infestation, which often included use of an illegal poison. Our findings support the need for interventions targeted at the individual and household levels to reduce risk of leptospirosis until large-scale structural interventions are available to residents of urban slum communities.

Community perception regarding rabies prevention and stray dog control in urban slums in India

The lack of community awareness about rabies control is a major issue that thwarts efforts to prevent human deaths caused by rabies. The objectives of this study were (1) to assess community knowledge and attitudes about rabies, rabies prevention and stray dog control in an urban slum community and (2) to determine the factors that influence rabies awareness in urban slums. Using a systematic random sampling strategy, 185 participants were selected from 8 urban slums. The data were collected by direct interview using a pre-tested, structured questionnaire. In the study population, 74.1% of the participants had heard about rabies, and 54.1% knew that rabies is a fatal disease. Only 33.5% of the interviewees felt that people in the community had a role to play in controlling the stray dog population. Gender, age and educational status were significantly associated with rabies awareness. Our study indicates that there are gaps in the knowledge and attitudes of individuals living in urban slums regarding rabies prevention and control. Efforts to promote awareness should be targeted at men, older people and uneducated individuals.

Caring for Caregivers of People Living with HIV in the Family: A Response to the HIV Pandemic from Two Urban Slum Communities in Pune, India

IntroductionIn low resource settings, the vast majority of ‘Person/people Living with HIV’ (PLHIV/s) and inadequate healthcare delivery systems to meet their treatment and care needs, caregivers play a vital role. Home based caregivers are often unrecognized with limited AIDS policies and programs focusing on them. We explored the perceptions and norms regarding care being provided by family caregivers of PLHIVs in India.MethodologyA community based qualitative study to understand the issues pertaining to home based care for PLHIV was conducted in urban settings of Pune city, in Maharashtra, India. Eight Focus Group Discussions (FGDs) among men, women and peer educators were carried out. A total of 44 in-depth Interviews (IDIs) with PLHIVs (20) and their caregivers (24), were conducted using separate guides respectively. Data was analyzed thematically.ResultsHome based care was perceived as economically viable option available for PLHIVs. ‘Care’ comprised of emotional, adherence, nursing and financial support to PLHIV. Home based care was preferred over hospital based care as it ensured confidentiality and patient care without hampering routine work at home. Women emerged as more vital primary caregivers compared to men. Home based care for men was almost unconditional while women had no such support. The natal family of women also abandoned. Their marital families seemed to provide support. Caregivers voiced the need for respite care and training.DiscussionGender related stigma and discrimination existed irrespective of women being the primary family caregivers. The support from marital families indicates a need to explore care and support issues at natal and marital homes of the women living with HIV respectively. Home based care training and respite care for the caregivers is recommended. Gender sensitive interventions addressing gender inequity and HIV related stigma should be modeled while designing interventions for PLHIVs and their family caregivers.

Socio-demographic determinants and prevalence of Tuberculosis knowledge in three slum populations of Uganda

BackgroundKnowledge of tuberculosis has been shown to influence health seeking behaviour; and urban slum dwellers are at a higher risk of acquiring tuberculosis than the general population. The study aim was to assess knowledge of tuberculosis and identify the associated socio-demographic determinants, in order to inform tailored interventions for advocacy, communication and social mobilisation in three urban-slum communities of Uganda.MethodsA cross-sectional survey of 1361 adults between April and October 2011. Data was analyzed by descriptive statistics. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) of potential determinants of tuberculosis (TB) knowledge were estimated by multivariable ordinal logistic regression using Stata 11.2 software.ResultsWe found low knowledge of TB cause (26.7%); symptoms (46.8%), transmission (54.3%), prevention (34%) and free treatment (35%). Knowledge about TB treatment (69.4) and cure (85.1) was relatively high. Independent determinants of poor knowledge of TB in the multivariable analysis included (aOR, 95% CI) lack of formal education (0.56; 0.38 – 0.83, P = 0.004), unemployment (0.67; 0.49 – 0.90, P = 0.010) and never testing for HIV (0.69; 0.51 – 0.92, P < 0.012). Whilst, older age (1.73; 1.30 – 2.29, P < 0.001) and residing in Lira (2.02; 1.50 – 2.72, P < 0.001) were independent determinants of higher knowledge of TB.ConclusionThis study revealed deficiencies in the public health knowledge about TB symptoms, diagnosis and treatment among urban-slum dwellers in Uganda. Tuberculosis control programmes in similar settings should consider innovative strategies for TB education, advocacy, communication and social mobilisation to reach the youth, unemployed and less-educated; as well as those who have never tested for HIV.

Virtual mate-seeking in the urban slums of Kolkata, India

This paper presents emerging research on young women's participation in virtual heterosexual mate-seeking in two bustees (urban slum communities) in Kolkata. I begin the paper by reviewing the context of online friendship, dating and romance in India. I show how greater educational and social achievements in the bustees are prompting some young Muslim women to pursue online friendship and mate-seeking. I explore how these young women are using schooling opportunities to learn computer skills, and using the computer to broaden their social worlds. I discuss the opportunities young women have to meet friends and partners online and how they sustain virtual relationships. For many, online friendships and mate-seeking can be a safe method to meet young men, as it reduces corporeal risks. This virtual world of relationships, however, is not entirely risk free. I discuss how the online nature of meeting young men is underpinned by discourses of distrust. Though the research group is small and participants represent a privileged population, the paper shows that virtual relationships are an emerging and experimental way young women are trying to alter their life course and expand their social circles.

Are Women More Likely to be Credit Constrained? Evidence from Low-Income Urban Households in the Philippines

Based on survey data for 2002 and 2006, this paper investigates the determinants of credit constraints among women and men in two urban slum communities of Manila in the Philippines. The results show that women are more likely to be credit constrained than men. Rather than wealth, informal lenders seem to rely more on reputation and credit history to screen prospective borrowers, and the consequences of repayment delays or defaults are more severe for women than for men. These findings provide empirical support for women-targeted credit interventions in urban poor contexts, particularly those that enable women to build and capitalize on good credit histories.

Burden and Determinants of Childhood Undernutrition in an Urban Slum Community in Ibadan, Nigeria

The objective of this study was to assess the burden and determinants of childhood undernutrition in an urban slum community in Ibadan, Nigeria. A 3‐stage stratified random sampling was used to select 273 children (0–24 months) from one slum community in the city of Ibadan. The prevalence of wasting, stunting and underweight was computed while the burden of undernutrition was calculated using the Composite Index of Anthropometric Failure (CIAF). There were 138 females and 135 males; mean age was 8.5 ± 6.3 months. Prevalence of wasting, stunting and underweight were found to be 9.9%, 47.6% and 21.6% respectively. Age groups 7–12 months and 19–24 months were at significantly higher risk of undernutrition. Using CIAF, six sub‐groups of single and multiple anthropometric failures were computed, giving an overall prevalence 57.1% as burden of undernutrition. Determinants of undernutrition in the community were mainly poor infant and young child feeding practices, poor environment and sub‐optimal care practices. Interventions based on improvement of infant and young child feeding, care and environmental health are needed in this community to reduce the high burden of childhood undernutrition.

A Case Control Study on School Dropouts in Children of Alcohol-Dependent Males Versus that in Abstainers/Social Drinkers' Children.

Objective:To study and compare in the children of alcohol-dependent males versus those in a socio-demographically similar control group, the occurrence of school dropouts, and to examine the link between certain factors like parental education and socioeconomic status on school dropout.Materials and Methods:This was a community-based case control study. The participants were 107 family units in both study group (alcohol-dependent male, wife, at least one child less than 14 years of age) and control group (abstainer/social drinker, wife, at least one child less than 14 years of age). It was conducted in an urban slum community in Mumbai. Interview technique was used for data collection. The study was conducted for a period of 1 year.Statistical Analysis:Using software SPSS version 17.0, percentages, Chi-square test.Results and Conclusion:The number of school dropouts was significantly higher (45.31%, P < 0.001) in the children of alcohol-dependent males as compared to 22.47% in the abstainers/social drinkers’ children. In the study group, there was higher number of school dropouts among boys (52.73%, P < 0.05) as compared to girls (35.37%). There was a statistically significant association between parental illiteracy and school dropout in children in both the groups. In the control group, significantly higher number of school dropouts of socioeconomic class IV and V had dropped out as compared to those of socioeconomic class III and II.

A Comparative Study of the Socio-Demographic Variables with Respect to the Knowledge of Bird Flu between a Rural and an Urban Slum Community of West Bengal, India

Every year in the early spring Bird Flu poses a threat to the community. H5N1 virus is also getting robust day by day acquiring an ability to cross the species barrier. It is now known as (H5N1) which is emerging as killer virus to man. Though human casualty is yet to be recorded from India but the threat is not over. Objectives of the study:1) To assess and compare the differences of knowledge and practice regarding Bird flu and poultry maintenance in between the rural and urban population. 2) To study the different socio-demographic factors responsible for this. Material and methods: The present study had been undertaken in the village of Hakimpur of Singur Block of District Hooghly, West Bengal with a population 862 of 215 families and in an urban slum of Chetla lockgate area of service area of Urban Health Centre Kolkata with a population of 1014 of 250 families. One responsible adult member from each family was interviewed. Information regarding socio-demographic profile, poultry keeping, correct knowledge about bird flu, mode of transmission, culling etc. was recorded. Result:The Results showed that 45.6% rural and 55.1% urban slum respondents know what Bird Flu is, 75.3% rural and 58.8% urban slum respondents know the mode of transmission, 32.6% rural and 31.2% urban slum respondents know the procedure of culling. The knowledge of transmission by Infected Body Fluids among Literate Respondents were significantly high than the Illiterate Respondents. The predominant source of information was Mass Media. 57.14% of the rural families rearing poultry, kept the birds in shed, 40.48% in cage and 2.38% in living room. 91.67% of the urban slum families rearing poultry kept birds in the cage and the rest of them kept birds in living room.39.2% urban slum respondents believe that isolation of diseased birds is helpful to arrest an outbreak and 44.7% rural respondents believe that the transmission of Bird Flu can be reduced by Culling at the time of an outbreak. 78% urban slum respondents believe that poultry products can be used at the time of an outbreak.

A Comparative Study of the Socio-Demographic Variables with Respect to the Knowledge of Bird Flu between a Rural and an Urban Slum Community of West Bengal, India

Every year in the early spring Bird Flu poses a threat to the community. H5N1 virus is also getting robust day by day acquiring an ability to cross the species barrier. It is now known as (H5N1) which is emerging as killer virus to man. Though human casualty is yet to be recorded from India but the threat is not over. Objectives of the study:1) To assess and compare the differences of knowledge and practice regarding Bird flu and poultry maintenance in between the rural and urban population. 2) To study the different socio-demographic factors responsible for this. Material and methods: The present study had been undertaken in the village of Hakimpur of Singur Block of District Hooghly, West Bengal with a population 862 of 215 families and in an urban slum of Chetla lockgate area of service area of Urban Health Centre Kolkata with a population of 1014 of 250 families. One responsible adult member from each family was interviewed. Information regarding socio-demographic profile, poultry keeping, correct knowledge about bird flu, mode of transmission, culling etc. was recorded. Result:The Results showed that 45.6% rural and 55.1% urban slum respondents know what Bird Flu is, 75.3% rural and 58.8% urban slum respondents know the mode of transmission, 32.6% rural and 31.2% urban slum respondents know the procedure of culling. The knowledge of transmission by Infected Body Fluids among Literate Respondents were significantly high than the Illiterate Respondents. The predominant source of information was Mass Media. 57.14% of the rural families rearing poultry, kept the birds in shed, 40.48% in cage and 2.38% in living room. 91.67% of the urban slum families rearing poultry kept birds in the cage and the rest of them kept birds in living room.39.2% urban slum respondents believe that isolation of diseased birds is helpful to arrest an outbreak and 44.7% rural respondents believe that the transmission of Bird Flu can be reduced by Culling at the time of an outbreak. 78% urban slum respondents believe that poultry products can be used at the time of an outbreak.

Maternal and neonatal health expenditure in mumbai slums (India): A cross sectional study

BackgroundThe cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty.MethodsWe used expenditure data for maternal and neonatal care, collected during post-partum interviews. Interviews were conducted in 2005-2006, with a sample of 1200 slum residents in Mumbai (India). We analysed expenditure by socio-economic status (SES), calculating a Kakwani Index for a range of spending categories. We also calculated catastrophic health spending both with and without adjustment for coping strategies. This identified the level of catastrophic payments incurred by a household and the prevalence of catastrophic payments in this population. The analysis also gave an understanding of the protection from medical poverty afforded by coping strategies (for example saving and borrowing).ResultsA high proportion of respondents spent catastrophically on care. Lower SES was associated with a higher proportion of informal payments. Indirect health expenditure was found to be (weakly) regressive as the poorest were more likely to use wage income to meet health expenses, while the less poor were more likely to use savings. Overall, the incidence of catastrophic maternity expenditure was 41%, or 15% when controlling for coping strategies. We found no significant difference in the incidence of catastrophic spending across wealth quintiles, nor could we conclude that total expenditure is regressive.ConclusionsHigh expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective is to increase institutional deliveries without forcing households deeper into poverty, these inequities will need to be addressed. Reducing out-of-pocket payments and better regulating informal payments should have direct benefits for the most poor. Alternatively, targeted schemes aimed at assisting the most poor in coping with maternal spending (including indirect spending) could reduce the household impact of high costs.

Role of probiotic in preventing acute diarrhoea in children: a community-based, randomized, double-blind placebo-controlled field trial in an urban slum

Acute diarrhoea remains a major public health challenge in developing countries. We examined the role of a probiotic in the prevention of acute diarrhoea to discover if there was an effect directed towards a specific aetiology. A double-blind, randomized, controlled field trial involving 3758 children aged 1-5 years was conducted in an urban slum community in Kolkata, India. Participants were given either a probiotic drink containing Lactobacillus casei strain Shirota or a nutrient drink daily for 12 weeks. They were followed up for another 12 weeks. The primary outcome of this study was the occurrence of first episodes of diarrhoea. We assessed this during 12 weeks of intake of study agent and also for 12 weeks of follow-up. There were 608 subjects with diarrhoea in the probiotic group and 674 subjects in the nutrient group during the study period of 24 weeks. The level of protective efficacy for the probiotic was 14% (95% confidence interval 4-23, P<0·01 in adjusted model). The reduced occurrence of acute diarrhoea in the probiotic group compared to nutrient group was not associated with any specific aetiology. No adverse event was observed in children of either probiotic or nutrient groups. The study suggests that daily intake of a probiotic drink can play a role in prevention of acute diarrhoea in young children in a community setting of a developing country.

Detection of closely related Picobirnaviruses among diarrhoeic children in Kolkata: Evidence of zoonoses?

The genus, Picobirnavirus (PBV), Spanish ‘pico’=‘small’, birna for ‘bipartite RNA’ genome, belongs to the family Picobirnaviridae under the proposed order Diplornavirales. PBV infections have been reported from diarrhoeic animal species and humans as well as from asymptomatic cases. The detection of Picobirnaviruses (PBVs) in diarrhoeic faecal specimens from children aged <5 years, suggestive of zoonotic transmission is being reported. 23 Picobirnavirus positive faecal specimens were detected by polyacrylamide gel electrophoresis (PAGE) and silver staining from a set of 1112 faecal specimens collected from an urban slum community in Kolkata between July and October 2007. The Picobirnaviruses showed either large profile (n=22) or small profile (n=1) for their bisegmented genomic double-stranded RNA (dsRNA). 13/23 positives were amplified by reverse transcription polymerase chain reaction (RT-PCR) as 201bp amplicon with genogroup I primers [PicoB25(+) and PicoB43(−) specific for RNA dependent RNA polymerase (RdRp) gene fragment encoded by genomic segment 2] and seven amplicons were sequenced [GPBV1–5, 7 and 8]. Sequence analyses showed that four PBV strains [GPBV1–3 and 8] resembled different clones of porcine PBV strains (D4, D6 and C10) reported in 2008 from Hungary and two PBV strains [GPBV4 and 7] resembled human PBV strains (P597, Kolkata and 2-GA-91, USA) with the maximum nucleotide (nt) identity ranging from 78% to 92%. One strain GPBV5 clustered with human PBVs and porcine PBVs that were reported from Hungary, Venezuela and Argentina showing close homology to human-like PBVs. Therefore, the close monitoring of their global spread as well as in-depth molecular characterization is essential for better understanding of emerging PBV strains.

Humanitarian engineering in Mylai Balaji Nagar: An integrated water, environment and public health project for slums in the Indian Subcontinent

Urban slum communities throughout the Indian subcontinent face critical challenges including inadequate access to safe water and environmental degradation, resulting in significant public health impacts. A research collaboration between Queen’s University and the Indian Institute of Technology (Madras) has been established on water, environment, and public health in slums, aiming to develop and evaluate technological and policy alternatives for sustainable safe water provision in slums. Point-of-use water quality treatment and detection techniques will be developed in the lab and then assessed for efficacy at controlling diarrhoeal and other water-borne diseases through a community-level integrated intervention in Mylai Balaji Nagar, Chennai, India. Reflecting the complexity of the issue, potential solutions must go beyond the technical to the social, economic, and political if they are to be sustainable; issues on water systems management will also be explored by the research collaboration.

Child morbidity and care-seeking in Nairobi slum settlements: the role of environmental and socio-economic factors

The aim of this study was to investigate factors that influence morbidity patterns and health-seeking decisions in an urban slum community. Data were collected between May and August 2003 as part of the ongoing Nairobi urban demographic surveillance system and were analysed to identify factors that influence morbidity patterns and health-seeking decisions. The results show that the factors that influenced morbidity were the child's age, ethnicity and type of toilet facility. Predictors for seeking health care were the child's age, type and severity of illness, survival of father and mother, mother's education, mother's work status and wealth class. The conclusions drawn show that economic resources fall short in preventing child illnesses where children live in poor environmental conditions. However, by enhancing access to health care services, socio-economic status is critical for mitigating disease burden among children in slum settlements.

Transmission of Streptococcus pneumoniae in an urban slum community

Inhabitants of slum settlements represent a significant proportion of the population at risk for pneumococcal disease in developing countries. We conducted a household survey of pneumococcal carriage among residents of a slum community in the city of Salvador, Brazil. Among 262 subjects, 95 (36%) were colonized with Streptococcus pneumoniae. Children <5 years of age (OR, 8.0; 95% CI, 3.5-18.6) and those who attended schools (OR, 2.7, 95% CI, 1.2-6.0) had significantly higher risk of being colonized. Of 94 isolates obtained from colonized individuals, 51% had serotypes included in the seven-valent pneumococcal conjugate vaccine. Overall, 10% (9 of 94 isolates) were nonsusceptible to penicillin and 28% (27 of 94 isolates) were resistant to cotrimoxazole. BOX-PCR, PFGE and MLST analyses found that 44% of the carriage isolates belonged to 14 distinct clonal groups. Strains of the same clonal group were isolated from multiple members of 9 out of the 39 study households. Nineteen carriage isolates had genotypes that were the same as those identified among 362 strains obtained from active surveillance for meningitis. The study's findings indicate that there is significant intra- and inter-household spread of S. pneumoniae in the slum community setting. However, a limited number of clones encountered during carriage among slum residents were found to cause invasive disease.

An evaluation of intravaginal rings as a potential HIV prevention device in urban Kenya: behaviors and attitudes that might influence uptake within a high-risk population.

We sought to assess the potential acceptability of intravaginal rings (IVRs) as an HIV prevention method among at-risk women and men. We conducted a qualitative assessment of initial attitudes toward IVRs, current HIV prevention methods, and common behavioral practices among female sex workers (FSWs) and men who frequent FSWs in Mukuru, an urban slum community in Nairobi, Kenya. Nineteen women and 21 men took part in six focus group discussions. Most participants, both male and female, responded positively to the concept of an IVR as a device for delivering microbicides. Women particularly liked the convenience offered by its slow-release capacity. Some female respondents raised concerns about whether male customers would discover the ring and respond negatively, whereas others thought it unlikely that their clients would feel the ring. Focus groups conducted with male clients of FSWs suggested that many would be enthusiastic about women, and particularly sex workers, using a microbicide ring, but that women's fears about negative responses to covert use were well founded. Overall, this high-risk population of FSWs and male clients in Nairobi was very open to the IVR as a potential HIV prevention device. Themes that emerged from the focus groups highlight the importance of understanding attitudes toward IVRs as well as cultural practices that may impact IVR use in high-risk populations when pursuing clinical development of this potential HIV prevention device.

Gap between awareness and practices regarding maternal and child health among women in an urban slum community

To investigate the knowledge of ever-married women regarding maternal and child health and to assess existing gap between awareness and practice levels of lactating mothers. Community based cross sectional study with 283 ever-married women in the reproductive age. Low levels of awareness and practice of TT immunization (74.2% awareness, 58.1% practice), five-cleans (31.9% awareness and 14.4% practice), trained birth attendant (69.6% awareness 39.1% practice), and post-natal care (75.4% awareness and 51.0% practice) among lactating mothers. Knowledge regarding optimal infant and young child feeding practices was very poor: initiation of breast-feeding within six hours (17.4%), colostrum feeding (34.8%), exclusive breastfeeding (5.8%) and significant gaps between knowledge and practice were observed. Highly significant difference (P<0.001) between proportions of women aware of ICDS (59.4%) and of beneficiaries (21.7%). High levels of awareness regarding reproductive health parameters except for contraception: desire for two children (81.6%), legal ages at marriages for girls (84.5%), desired birth interval of three or more years (71.7%). Wide gaps exist between awareness and practices related with MCH due to non-adoption of knowledge into actual practice, except some selected components lacking in both knowledge as well as practice. Need for bridging the existing gaps avoiding socio-cultural barriers and misconceptions prevailing in the community and by promoting and protecting healthy MCH care practices.

Cluster-randomised controlled trial of community mobilisation in Mumbai slums to improve care during pregnancy, delivery, postpartum and for the newborn.

BackgroundThe United Nations Millennium Development Goals look to substantial improvements in child and maternal survival. Morbidity and mortality during pregnancy, delivery and the postnatal period are prime obstacles to achieving these goals. Given the increasing importance of urban health to global prospects, Mumbai's City Initiative for Newborn Health aims to improve maternal and neonatal health in vulnerable urban slum communities, through a combination of health service quality improvement and community participation. The protocol describes a trial of community intervention aimed at improving prevention, care seeking and outcomes.ObjectiveTo test an intervention that supports local women as facilitators in mobilising communities for better health care. Community women's groups will build an understanding of their potential to improve maternal and infant health, and develop and implement strategies to do so.DesignCluster-randomized controlled trial.MethodsThe intervention will employ local community-based female facilitators to convene groups and help them to explore maternal and neonatal health issues. Groups will meet fortnightly through a seven-phase process of sharing experiences, discussion of the issues raised, discovery of potential community strengths, building of a vision for action, design and implementation of community strategies, and evaluation.The unit of allocation will be an urban slum cluster of 1000–1500 households. 48 clusters have been randomly selected after stratification by ward. 24 clusters have been randomly allocated to receive the community intervention. 24 clusters will act as control groups, but will benefit from health service quality improvement. Indicators of effect will be measured through a surveillance system implemented by the project. Key distal outcome indicators will be neonatal mortality and maternal and neonatal morbidity. Key proximate outcome indicators will be home care practices, uptake of antenatal, delivery and postnatal care, and care for maternal and neonatal illness.Data will be collected through a vital registration system for births and deaths in the 48 study clusters. Structured interviews with families will be conducted at about 6 weeks after index deliveries. We will also collect both quantitative and qualitative data to support a process evaluation.Trial registrationCurrent controlled trials ISRCTN96256793