Tim Colbourn|Bejoy Nambiar|Austin Bondo|Charles Makwenda|E. Tsetekani|A. Makonda-Ridley|M. Msukwa|Pierre Barker|Uma R. Kotagal|Connie Williams|Rowena Davies|D. Webb|Dorothy Flatman|Sonia Lewycka|Mikey Rosato|Fannie Kachale|Charles Mwansambo|A. Costello
Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial
George Institute for Global Health|University College London|University College London|George Institute for Global Health|Institute for Healthcare Improvement|Cincinnati Children's Hospital Medical Center|Health Foundation|Health Foundation|University College London|George Institute for Global Health|University College London|George Institute for Global Health|Malawi Government|Ministry of Health|Malawi Government|Ministry of Health|University College London|George Institute for Global Health
maternal perinatal neonatal mortality remains high lowincome countries evaluated community facilitybased interventions reduce deaths three districts malawiwe evaluated rural participatory womens group community intervention ci quality improvement intervention health centres fi via twobytwo factorial cluster randomized controlled trial consenting pregnant women followedup 2 months birth using key informants primary outcomes maternal perinatal neonatal mortality clusters health centre catchment areas assigned using stratified computergenerated randomization following exclusions including nonbirthing facilities 61 clusters analysed control 17 clusters 4912 births fi 15 5335 ci 15 5080 fi ci 14 5249 trial registered international standard randomised controlled trial isrctn18073903 outcomes 14576 20576 births recorded baseline june 2007september 2008 intervention october 2008december 2010 periodsfor control fi ci fi ci clusters neonatal mortality rates 340 283 299 270 neonatal deaths per 1000 live births perinatal mortality rates 562 551 480 484 per 1000 births intervention period adjusting clustering stratification neonatal mortality rate 22 lower fi ci control clusters 078 95 ci 060101 perinatal mortality rate 16 lower ci clusters 084 95 ci 072097 observe intervention effects maternal mortalitydespite implementation problems combined community facility approach using participatory womens groups quality improvement health centres reduced newborn mortality rural malawi