***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Objectives : Community-based maternal and newborn intervention packages have been shown to reduce neonatal mortality in re source -constrained setting s. This analysis uses data from a large community-based cluster-r and omized trial to assess the impact of a community-based package on cause-specific neonatal mortality and draws programmatic and policy implication s. In addition , the study shows that cause-specific mortality estimates vary substantially based on the hierarchy used in assigning cause of death , which also has important implication s for program planning . Therefore , underst and ing the methods of assigning causes of deaths is important , as is the development of new method ologies that account for multiple causes of death . The objective of this study was to estimate the effect of two service delivery strategies ( home care and community care ) for a community-based package of maternal and neonatal health interventions on cause-specific neonatal mortality rates in a rural district of Bangladesh . Study design : Within the general community of the Sylhet district in rural northeast Bangladesh . Pregnancy histories were collected from a sample of women in the study area during the year preceding the study ( 2002 ) and from all women who reported a pregnancy outcome during the intervention in years 2004 to 2005 . All families that reported a neonatal death during these time periods were asked to complete a  verbal autopsy interview  . Expert algorithms with two different hierarchies were used to assign causes of neonatal death , varying in placement of the preterm/low birth weight category within the hierarchy ( either third or last ) . The main outcome measure was cause-specific neonatal mortality . Result : Deaths because of serious infections in the home-care arm declined from 13.6 deaths per 1000 live births during the baseline period to 7.2 during the intervention period according to the first hierarchy ( preterm placed third ) and from 23.6 to 10.6 according to the second hierarchy ( preterm placed last ) . Conclusion : This study confirms the high burden of neonatal deaths because of infection in low re source rural setting s like Bangladesh , where most births occur at home in the absence of skilled birth attendance and care seeking for newborn illnesses is low . The study demonstrates that a package of community-based neonatal health interventions , focusing primarily on infection prevention and management , can substantially reduce infection-related neonatal mortality Summary Background Around 30 % of the world 's stunted children live in India . The Government of India has proposed a new cadre of community-based workers to improve nutrition in 200 districts . We aim ed to find out the effect of such a worker carrying out home visits and participatory group meetings on children 's linear growth . Methods We did a cluster-r and omised controlled trial in two adjoining districts of Jharkh and and Odisha , India . 120 clusters ( around 1000 people each ) were r and omly allocated to intervention or control using a lottery . R and omisation took place in July , 2013 , and was stratified by district and number of hamlets per cluster ( 0 , 1–2 , or ≥3 ) , result ing in six strata . In each intervention cluster , a worker carried out one home visit in the third trimester of pregnancy , monthly visits to children younger than 2 years to support feeding , hygiene , care , and stimulation , as well as monthly women 's group meetings to promote individual and community action for nutrition . Participants were pregnant women identified and recruited in the study clusters and their children . We excluded stillbirths and neonatal deaths , infants whose mothers died , those with congenital abnormalities , multiple births , and mother and infant pairs who migrated out of the study area permanently during the trial period . Data collectors visited each woman in pregnancy , within 72 h of her baby 's birth , and at 3 , 6 , 9 , 12 , and 18 months after birth . The primary outcome was children 's length-for-age Z score at 18 months of age . Analyses were by intention to treat . Due to the nature of the intervention , participants and the intervention team were not masked to allocation . Data collectors and the data manager were masked to allocation . The trial is registered as ISCRTN ( 51505201 ) and with the Clinical Trials Registry of India ( number 2014/06/004664 ) . Results Between Oct 1 , 2013 , and Dec 31 , 2015 , we recruited 5781 pregnant women . 3001 infants were born to pregnant women recruited between Oct 1 , 2013 , and Feb 10 , 2015 , and were therefore eligible for follow-up ( 1460 assigned to intervention ; 1541 assigned to control ) . Three groups of children could not be included in the final analysis : 147 migrated out of the study area ( 67 in intervention clusters ; 80 in control clusters ) , 77 died after the neonatal period and before 18 months ( 31 in intervention clusters ; 46 in control clusters ) , and seven had implausible length-for-age Z scores ( < –5 SD ; one in intervention cluster ; six in control clusters ) . We measured 1253 ( 92 % ) of 1362 eligible children at 18 months in intervention clusters , and 1308 ( 92 % ) of 1415 eligible children in control clusters . Mean length-for-age Z score at 18 months was −2·31 ( SD 1·12 ) in intervention clusters and −2·40 ( SD 1·10 ) in control clusters ( adjusted difference 0·107 , 95 % CI −0·011 to 0·226 , p=0·08 ) . The intervention did not significantly affect exclusive breastfeeding , timely introduction of complementary foods , morbidity , appropriate home care or care-seeking during childhood illnesses . In intervention clusters , more pregnant women and children attained minimum dietary diversity ( adjusted odds ratio [ aOR ] for women 1·39 , 95 % CI 1·03–1·90 ; for children 1·47 , 1·07–2·02 ) , more mothers washed their h and s before feeding children ( 5·23 , 2·61–10·5 ) , fewer children were underweight at 18 months ( 0·81 , 0·66–0·99 ) , and fewer infants died ( 0·63 , 0·39–1·00 ) . Interpretation Introduction of a new worker in areas with a high burden of undernutrition in rural eastern India did not significantly increase children 's length . However , certain secondary outcomes such as self-reported dietary diversity and h and washing , as well as infant survival were improved . The interventions tested in this trial can be further optimised for use at scale , but substantial improvements in growth will require investment in nutrition-sensitive interventions , including clean water , sanitation , family planning , girls ' education , and social safety nets . Funding UK Medical Research Council , Wellcome Trust , UK Department for International Development ( DFID ) Background To evaluate a delivery strategy for newborn interventions in rural Bangladesh . Methods A cluster-r and omized controlled trial was conducted in Mirzapur , Bangladesh . Twelve unions were r and omized to intervention or comparison arm . All women of reproductive age were eligible to participate . In the intervention arm , community health workers identified pregnant women ; made two antenatal home visits to promote birth and newborn care preparedness ; made four postnatal home visits to negotiate preventive care practice s and to assess newborns for illness ; and referred sick neonates to a hospital and facilitated compliance . Primary outcome measures were antenatal and immediate newborn care behaviours , knowledge of danger signs , care seeking for neonatal complications , and neonatal mortality . Findings A total of 4616 and 5241 live births were recorded from 9987 and 11153 participants in the intervention and comparison arm , respectively . High coverage of antenatal ( 91 % visited twice ) and postnatal ( 69 % visited on days 0 or 1 ) home visitations was achieved . Indicators of care practice s and knowledge of maternal and neonatal danger signs improved . Adjusted mortality hazard ratio in the intervention arm , compared to the comparison arm , was 1.02 ( 95 % CI : 0.80–1.30 ) at baseline and 0.87 ( 95 % CI : 0.68–1.12 ) at endline . Primary causes of death were birth asphyxia ( 49 % ) and prematurity ( 26 % ) . No adverse events associated with interventions were reported . Conclusion Lack of evidence for mortality impact despite high program coverage and quality assurance of implementation , and improvements in targeted newborn care practice s suggests the intervention did not adequately address risk factors for mortality . The level and cause-structure of neonatal mortality in the local population must be considered in developing interventions . Programs must ensure skilled care during childbirth , including management of birth asphyxia and prematurity , and curative postnatal care during the first two days of life , in addition to essential newborn care and infection prevention and management . Trial Registration Clinical trials.gov BACKGROUND Neonatal deaths in developing countries make the largest contribution to global mortality in children younger than 5 years . 90 % of deliveries in the poorest quintile of households happen at home . We postulated that a community-based participatory intervention could significantly reduce neonatal mortality rates . METHODS We pair-matched 42 geopolitical clusters in Makwanpur district , Nepal , selected 12 pairs r and omly , and r and omly assigned one of each pair to intervention or control . In each intervention cluster ( average population 7000 ) , a female facilitator convened nine women 's group meetings every month . The facilitator supported groups through an action-learning cycle in which they identified local perinatal problems and formulated strategies to address them . We monitored birth outcomes in a cohort of 28?931 women , of whom 8 % joined the groups . The primary outcome was neonatal mortality rate . Other outcomes included stillbirths and maternal deaths , uptake of antenatal and delivery services , home care practice s , infant morbidity , and health-care seeking . Analysis was by intention to treat . The study is registered as an International St and ard R and omised Controlled Trial , number IS RCT N31137309 . FINDINGS From 2001 to 2003 , the neonatal mortality rate was 26.2 per 1000 ( 76 deaths per 2899 livebirths ) in intervention clusters compared with 36.9 per 1000 ( 119 deaths per 3226 livebirths ) in controls ( adjusted odds ratio 0.70 [ 95 % CI 0.53 - 0.94 ] ) . Stillbirth rates were similar in both groups . The maternal mortality ratio was 69 per 100000 ( two deaths per 2899 livebirths ) in intervention clusters compared with 341 per 100000 ( 11 deaths per 3226 livebirths ) in control clusters ( 0.22 [ 0.05 - 0.90 ] ) . Women in intervention clusters were more likely to have antenatal care , institutional delivery , trained birth attendance , and hygienic care than were controls . INTERPRETATION Birth outcomes in a poor rural population improved greatly through a low cost , potentially sustainable and scalable , participatory intervention with women 's groups Objective To evaluate the Indian Integrated Management of Neonatal and Childhood Illness ( IMNCI ) programme , which integrates improved treatment of illness for children with home visits for newborn care  , to inform its scale-up . Design Cluster r and omised trial . Setting 18 clusters ( population 1.1 million ) in Haryana , India . Participants 29 667 births in intervention clusters and 30 813 in control clusters . Intervention Community health workers were trained to conduct postnatal home visits and women ’s group meetings ; physicians , nurses , and community health workers were trained to treat or refer sick newborns and children ; supply of drugs and supervision were strengthened . Main outcome measures Neonatal and infant mortality ; newborn care practice s. Results The infant mortality rate ( adjusted hazard ratio 0.85 , 95 % confidence interval 0.77 to 0.94 ) and the neonatal mortality rate beyond the first 24 hours ( adjusted hazard ratio 0.86 , 0.79 to 0.95 ) were significantly lower in the intervention clusters than in control clusters . The adjusted hazard ratio for neonatal mortality rate was 0.91 ( 0.80 to 1.03 ) . A significant interaction was found between the place of birth and the effect of the intervention for all mortality outcomes except post-neonatal mortality rate . The neonatal mortality rate was significantly lower in the intervention clusters in the subgroup born at home ( adjusted hazard ratio 0.80 , 0.68 to 0.93 ) but not in the subgroup born in a health facility ( 1.06 , 0.91 to1.23 ) ( P value for interaction=0.001 ) . Optimal newborn care practice s were significantly more common in the intervention clusters . Conclusions Implementation of the IMNCI result ed in substantial improvement in infant survival and in neonatal survival in those born at home . The IMNCI should be a part of India ’s strategy to achieve the millennium development goal on child survival . Trial registration Clinical trials NCT00474981 ; ICMR Clinical Trial Registry CTRI/2009/091/000715 Background We report a cluster-r and omised trial of a home-based counselling strategy , design ed for large-scale implementation , in a population of 1.2 million people in rural southern Tanz 
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= − 7.870 ; p = .164).According to the World Health Organization ’s Choosing Interventions that are Cost-Effective project recommendations , home-based neonatal care strategy was found to be cost-effective .
Conclusions Home visits and community mobilization activities to promote neonatal care practice s by community health workers is associated with reduced neonatal mortality , increased practice of exclusive breastfeeding , and cost-effective in improving newborn health outcomes for low- and -middle-income countries .