Lewycka, S.O.; (2011) Reducing maternal and neonatal deaths in rural Malawi: evaluating the impact of a community-based women’s group intervention. Doctoral thesis , UCL (University College London).

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Abstract

Background: Maternal and neonatal mortality are high in Malawi, and cost-effective and sustainable interventions are needed in order to reduce mortality rates and make progress to achieve Millennium Development Goals 4 and 5 for mother and child health. Where health systems are weak and many women deliver at home, community-based interventions have the potential to make an important contribution to health improvements. Methods: A cluster-randomised study with a factorial design was used to evaluate the impact of two community-based interventions on maternal and child health outcomes. A prospective pregnancy and birth monitoring system was developed to collect information on pre-specified pregnancy, birth and infant outcomes. The research presented here focuses on the women’s group intervention, which uses participatory methods to mobilise communities to take actions for maternal and child health problems they identify. Results: 18,562 pregnancies were followed up, resulting in 18,340 live births, 362 stillbirths, 434 neonatal deaths and 73 maternal deaths. 11,450 live births were identified retrospectively, resulting in 484 infant deaths. Statistically significant reductions in maternal and neonatal mortality as a result of the women’s group intervention were not seen (adjusted odds ratio 0.94 (95% CI 0.56-1.61) and 0.95 (95% CI 0.71-1.28) respectively). There were significant improvements in antenatal care and immunisation, and reductions in births attended by traditional birth attendants, and there were non-significant reductions in mortality and increases in health-care seeking. Discussion: Although women’s groups showed promising signs of community-level action for mother and child health, methodological factors, such as low power and baseline imbalance after randomisation, may have limited the ability of this study to detect an impact of the intervention on mother and child health outcomes. Design and implementation factors may also have caused delays and limited the measurable impact of the intervention at this time. Follow-up over a longer period may show greater impact.

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