***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The continued high mortality and morbidity rates for unintentional childhood injuries remain a public health concern . This article reports on the influence of a home visitation programme ( HVP ) on household hazards associated with unintentional childhood injuries in a South African low-income setting . METHODS A r and omised controlled trial ( n=211 households ) was conducted in a South African informal settlement . Community members were recruited and trained as paraprofessional visitors . Four intervention visits were conducted over 3 months , focusing on child development , and the prevention of burn , poison , and fall injuries . The HVP , a multi-component intervention , included educational inputs , provision of safety devices , and an implicit enforcement strategy . The intervention effect ( IE ) was measured with a st and ardised risk assessment index that compared post-intervention scores for intervention and control households . RESULTS A significant reduction was observed in the hazards associated with electrical and paraffin appliances , as well as in hazards related to poisoning . Non-significant changes were observed for burn safety household practice s and fall injury hazards . CONCLUSIONS This study confirmed that a multi-component HVP effectively reduced household hazards associated with electrical and paraffin appliances and poisoning among children in a low-income South African setting Background Guinea-Bissau is a small country in West Africa with a population of 1.7 million . The WHO and UNICEF reported an under-five child mortality of 203 per 1000 , the 10th highest amongst 192 countries . The aim of the trial is to assess whether an intervention package that includes community health promotion campaign and education through health clubs , intensive training and mentoring of village health workers to diagnose and provide first-line treatment for children 's diseases within the community , and improved outreach services can generate a rapid and cost-effective reduction in under-five child mortality in rural regions of Guinea-Bissau . Effective Intervention plans to exp and the project to a much larger region if there is good evidence after two and a half years that the project is generating a cost-effective , sustainable reduction in child mortality . Methods / design This trial is a cluster-r and omised controlled trial involving 146 clusters . The trial will run for 2.5 years . The interventions will be introduced in two stages : seventy-three clusters will receive the interventions at the start of the project , and seventy-three control clusters will receive the interventions 2.5 years after the first clusters have received all interventions if the research shows that the interventions are effective . The impact of the interventions and cost-effectiveness will be measured during the first stage . The package of interventions includes a community health promotion campaign and education through health clubs , and intensive training and mentoring of village health workers to diagnose and provide first-line treatment for common children 's diseases within the community . It also includes improved outreach services to encourage provision of antenatal and post natal care and provide ongoing monitoring for village health workers . The primary outcome of the trial will be the proportion of children that die under 5 years of age during the trial . Secondary outcomes will include age at and cause of child deaths , neonatal mortality , infant mortality , maternal mortality , health knowledge , health seeking behaviour , morbidity and costs . Discussion The trial will be run by research and service delivery teams that act independently , overseen by a trial steering committee . A data monitoring committee will be appointed to monitor the outcome and any adverse effects . Trial Registration Current Controlled Trials IS RCT Background Maternal and newborn mortality rates remain unacceptably high , especially where the majority of births occur in home setting s or in facilities with inadequate re sources . The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes . However , the effectiveness of emergency obstetric and neonatal care services has never been proven . Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes . Methods / Design We have developed a cluster-r and omized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization , birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities . This trial will take place in 106 clusters ( 300 - 500 deliveries per year each ) across 7 sites of the Global Network for Women 's and Children 's Health Research in Argentina , Guatemala , India , Kenya , Pakistan and Zambia . The trial intervention has three key elements , community mobilization , home-based life saving skills for communities and birth attendants , and training of providers at obstetric facilities to improve quality of care . The primary outcome of the trial is perinatal mortality . Secondary outcomes include rates of stillbirth , 7-day neonatal mortality , maternal death or severe morbidity ( including obstetric fistula , eclampsia and obstetrical sepsis ) and 28-day neonatal mortality . Discussion In this trial , we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes . If successful , the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries . Trial Registration Clinical Trials.gov Background A community-based r and omized control prenatal care trial was performed in a rural county of China during 2000 - 2003 . The purpose of this paper is to describe the trial implementation and the impact of the trial on the utilization of prenatal care and perinatal outcomes . Material s and methods In the study county , 10 townships ( from a total of 55 ) were each paired with a control ( 20 study townships in total ) , with the criteria for pairing being the township 's socioeconomic development , perinatal health , and maternal care utilization and provision . One of each township pair was r and omly allocated to the intervention or control groups . The trial interventions were : 1 ) training township hospital midwives and instructing them in how to provide systematic maternal care , 2 ) informing women in the community of the importance of prenatal care , 3 ) if needed , providing basic medical instruments to the hospitals . A variety of data sources were used to describe the trial implementation ( observations , group discussion s , field notes , survey to women ) . The data on pregnancy and perinatal outcomes were from the original h and -written work-records in the village family planning centers of the study townships . Results Implementation of the intervention was deficient . The factors hindering the trial implementation included poor coordination between midwives and family planning officers , broader policy changes implemented by the provincial government during the trial , the de central ization of county governance , and the lack of government funding for maternal care . There was only little difference in the use of maternal care , in women 's opinions related to maternal care or content of prenatal care , and no difference in the perinatal outcomes between the intervention and control townships . Conclusions A community based r and omized controlled trial could not be fully carried out in rural China as planned due to the changing political l and scape , the complexity of the socio-economic situation and a lengthy planning stage . The study could not answer if perinatal outcomes could be improved by increased use of prenatal care . Trial registration NCT Background The World Health Organization recommends dry cord care for newborns but this recommendation may not be optimal in low re source setting s where most births take place in an unclean environment and infections account for up to half of neonatal deaths . A previous trial in Nepal indicated that umbilical cord cleansing with 4.0 % chlorhexidine could substantially reduce mortality and omphalitis risk , but policy changes await additional community-based data . Methods The Projahnmo Chlorhexidine study was a three-year , cluster-r and omized , community-based trial to assess the impact of three cord care regimens on neonatal mortality and omphalitis .  Women were recruited mid-pregnancy , received a basic package of maternal and neonatal health promotion messages , and were followed to pregnancy outcome . Newborns were visited at home by local village-based workers whose areas were r and omized to either 1 ) single- or 2 ) 7-day cord cleansing with 4.0 % chlorhexidine , or 3 ) promotion of dry cord care as recommended by WHO . All mothers received basic messages regarding h and -washing , clean cord cutting , and avoidance of harmful home-base applications to the cord . Death within 28 days and omphalitis were the primary outcomes ; these were monitored directly through home visits by community health workers on days 1 , 3 , 6 , 9 , 15 , and 28 after birth . Discussion Due to report in early 2010 , the Projahnmo Chlorhexidine Study examines the impact of multiple or single chlorhexidine cleansing of the cord on neonatal mortality and omphalitis  among newborns of rural Sylhet District , Bangladesh . The results of this trial will be interpreted in conjunction with a similarly design ed trial previously conducted in Nepal , and will have implication s for policy guidelines for optimal cord care of newborns in low re source setting s in Asia . Trial Registration Clinical Trials.gov ( NCT00434408 BACKGROUND Most mothers breastfeed in Bangladesh , but they rarely practise exclusive breastfeeding . Hospital-based strategies for breastfeeding promotion can not reach them because about 95 % have home deliveries . We postulated that with the intervention of trained peer counsellors , mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months . METHODS 40 adjacent zones in Dhaka were r and omised to intervention or control groups . Women were enrolled during the last trimester of pregnancy between February and December , 1996 . In the intervention group , 15 home-based counselling visits were scheduled , with two visits in the last trimester , three early postpartum ( within 48 h , on day 5 , between days 10 and 14 ) , and fortnightly thereafter until the infant was 5 months old . Peer counsellors were local mothers who received 10 days ' training . FINDINGS 363 women were enrolled in each group .  Peer counselling significantly improved breastfeeding practice s. For the primary outcome , the prevalence of exclusive breastfeeding at 5 months was 202/228 ( 70 % ) for the intervention group and 17/285 ( 6 % ) for the control group ( difference=64 % ; 95 % CI 57%-71 % , p>0.0001 ) . For the secondary outcomes , mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods . At day 4 , significantly more mothers in the intervention group breastfed exclusively than controls . INTERPRETATION Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding . We recommend incorporation of peer counsellors in mother and child health programmes in developing countries Various community-based interventions have been proposed to improve maternity care , but hardly any studies have reported the effect of these measures on maternal mortality . In this study , the efficacy of a maternity-care programme to reduce  maternal mortality has been evaluated in the context of a primary health-care project in rural Bangladesh .  Trained midwives were posted in villages , and asked to attend as many home-deliveries as possible , detect and manage obstetric complications at onset , and accompany patients requiring referral for higher-level care to the project central maternity clinic . The effect of the programme was evaluated by comparison of direct obstetric maternal mortality ratios between the programme area and a neighbouring control area  without midwives . R and om assignment of the intervention was not possible but potentially confounding characteristics , including coverage and use of other health and family planning services , were similar in both areas . Maternal mortality ratios due to obstetric complications were similar in both areas during the 3 years preceding the start of the programme . By contrast , during the following 3 years , the ratio was significantly lower in the programme than in the control area ( 1.4 vs 3.8 per 1000 live births , p = 0.02 ) . The findings suggest that maternal survival can be improved by the posting of midwives at village level , if they are given proper training , means , supervision , and back-up . The inputs for such a programme to succeed and the constraints of its replication on a large scale should not be underestimated 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 
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Subgroup and meta-regression analyses suggested a greater effect with a higher baseline neonatal mortality rate .
The authors concluded that home-based neonatal care is associated with a reduction in neonatal and perinatal mortality in South Asian setting s with high neonatal-mortality rates and poor access to health facility-based care .
Adoption of a policy of home-based neonatal care provided by CHWs is justified in such setting