Effects of women's groups practising participatory learning and action on preventive and care-seeking behaviours to reduce neonatal mortality: A meta-analysis of cluster-randomised trials.

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dc.contributor.author Seward, Nadine en
dc.contributor.author Neuman, Melissa en
dc.contributor.author Colbourn, Tim en
dc.contributor.author Osrin, David en
dc.contributor.author Lewycka, Sonia en
dc.contributor.author Lewycka, Sonia en
dc.contributor.author Azad, Kishwar en
dc.contributor.author Costello, Anthony en
dc.contributor.author Das, Sushmita en
dc.contributor.author Fottrell, Edward en
dc.contributor.author Kuddus, Abdul en
dc.contributor.author Manandhar, Dharma en
dc.contributor.author Nair, Nirmala en
dc.contributor.author Nambiar, Bejoy en
dc.contributor.author Shah More, Neena en
dc.contributor.author Phiri, Tambosi en
dc.contributor.author Tripathy, Prasanta en
dc.contributor.author Prost, Audrey en
dc.date.accessioned 2018-12-02T21:57:39Z en
dc.date.issued 2017-12-05 en
dc.identifier.citation PLoS medicine 14(12):e1002467 05 Dec 2017 en
dc.identifier.issn 1549-1676 en
dc.identifier.uri http://hdl.handle.net/2292/44737 en
dc.description.abstract The World Health Organization recommends participatory learning and action (PLA) in women's groups to improve maternal and newborn health, particularly in rural settings with low access to health services. There have been calls to understand the pathways through which this community intervention may affect neonatal mortality. We examined the effect of women's groups on key antenatal, delivery, and postnatal behaviours in order to understand pathways to mortality reduction.We conducted a meta-analysis using data from 7 cluster-randomised controlled trials that took place between 2001 and 2012 in rural India (2 trials), urban India (1 trial), rural Bangladesh (2 trials), rural Nepal (1 trial), and rural Malawi (1 trial), with the number of participants ranging between 6,125 and 29,901 live births. Behavioural outcomes included appropriate antenatal care, facility delivery, use of a safe delivery kit, hand washing by the birth attendant prior to delivery, use of a sterilised instrument to cut the umbilical cord, immediate wrapping of the newborn after delivery, delayed bathing of the newborn, early initiation of breastfeeding, and exclusive breastfeeding. We used 2-stage meta-analysis techniques to estimate the effect of the women's group intervention on behavioural outcomes. In the first stage, we used random effects models with individual patient data to assess the effect of groups on outcomes separately for the different trials. In the second stage of the meta-analysis, random effects models were applied using summary-level estimates calculated in the first stage of the analysis. To determine whether behaviour change was related to group attendance, we used random effects models to assess associations between outcomes and the following categories of group attendance and allocation: women attending a group and allocated to the intervention arm; women not attending a group but allocated to the intervention arm; and women allocated to the control arm. Overall, women's groups practising PLA improved behaviours during and after home deliveries, including the use of safe delivery kits (odds ratio [OR] 2.92, 95% CI 2.02-4.22; I2 = 63.7%, 95% CI 4.4%-86.2%), use of a sterile blade to cut the umbilical cord (1.88, 1.25-2.82; 67.6%, 16.1%-87.5%), birth attendant washing hands prior to delivery (1.87, 1.19-2.95; 79%, 53.8%-90.4%), delayed bathing of the newborn for at least 24 hours (1.47, 1.09-1.99; 68.0%, 29.2%-85.6%), and wrapping the newborn within 10 minutes of delivery (1.27, 1.02-1.60; 0.0%, 0%-79.2%). Effects were partly dependent on the proportion of pregnant women attending groups. We did not find evidence of effects on uptake of antenatal care (OR 1.03, 95% CI 0.77-1.38; I2 = 86.3%, 95% CI 73.8%-92.8%), facility delivery (1.02, 0.93-1.12; 21.4%, 0%-65.8%), initiating breastfeeding within 1 hour (1.08, 0.85-1.39; 76.6%, 50.9%-88.8%), or exclusive breastfeeding for 6 weeks after delivery (1.18, 0.93-1.48; 72.9%, 37.8%-88.2%). The main limitation of our analysis is the high degree of heterogeneity for effects on most behaviours, possibly due to the limited number of trials involving women's groups and context-specific effects.This meta-analysis suggests that women's groups practising PLA improve key behaviours on the pathway to neonatal mortality, with the strongest evidence for home care behaviours and practices during home deliveries. A lack of consistency in improved behaviours across all trials may reflect differences in local priorities, capabilities, and the responsiveness of health services. Future research could address the mechanisms behind how PLA improves survival, in order to adapt this method to improve maternal and newborn health in different contexts, as well as improve other outcomes across the continuum of care for women, children, and adolescents. en
dc.format.medium Electronic-eCollection en
dc.language eng en
dc.relation.ispartofseries PLoS medicine en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.rights.uri https://creativecommons.org/licenses/by/4.0/ en
dc.subject Humans en
dc.subject Prenatal Care en
dc.subject Infant Mortality en
dc.subject Health Behavior en
dc.subject Pregnancy en
dc.subject Developing Countries en
dc.subject Infant en
dc.subject Infant, Newborn en
dc.subject Women en
dc.subject Malawi en
dc.subject Bangladesh en
dc.subject India en
dc.subject Nepal en
dc.subject Female en
dc.subject Randomized Controlled Trials as Topic en
dc.subject Community-Based Participatory Research en
dc.subject Community Participation en
dc.title Effects of women's groups practising participatory learning and action on preventive and care-seeking behaviours to reduce neonatal mortality: A meta-analysis of cluster-randomised trials. en
dc.type Journal Article en
dc.identifier.doi 10.1371/journal.pmed.1002467 en
pubs.issue 12 en
pubs.begin-page e1002467 en
pubs.volume 14 en
dc.rights.holder Copyright: The authors en
dc.identifier.pmid 29206833 en
pubs.publication-status Published en
dc.rights.accessrights http://purl.org/eprint/accessRights/OpenAccess en
pubs.subtype Meta-Analysis en
pubs.subtype research-article en
pubs.subtype Journal Article en
pubs.elements-id 719365 en
dc.identifier.eissn 1549-1676 en
pubs.record-created-at-source-date 2017-12-06 en
pubs.dimensions-id 29206833 en

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