***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: David Osrin and colleagues report findings from a cluster-r and omized trial conducted in Mumbai slums ; the trial aim ed to evaluate whether  facilitator-supported women 's groups  could improve perinatal outcomes Background Interventions are needed to reduce poor perinatal health . We trained community health workers ( CHWs ) as home visitors to address maternal/infant risks . Methods In a cluster r and omised controlled trial in Cape Town townships , neighbourhoods were r and omised within matched pairs to 1 ) the  control , healthcare at clinics ( n = 12 neighbourhoods ; n = 594 women ) , or 2 )  a home visiting intervention by CBW trained in cognitive-behavioural strategies to address health risks ( by the Philani Maternal , Child Health and Nutrition Programme )  , in addition to clinic care ( n = 12 neighbourhoods ; n = 644 women ) . Participants were assessed during pregnancy ( 2 % refusal ) and 92 % were reassessed at two weeks post-birth , 88 % at six months and 84 % at 18 months later . We analysed 32 measures of maternal/infant well-being over the 18 month follow-up period using longitudinal r and om effects regressions . A binomial test for correlated outcomes evaluated overall effectiveness over time . The 18 month post-birth assessment outcomes also were examined alone and as a function of the number of home visits received . Results Benefits were found on 7 of 32 measures of outcomes , result ing in significant overall benefits for the intervention compared to the control when using the binomial test ( p = 0.008 ) ; nevertheless , no effects were observed when only the 18 month outcomes were analyzed . Benefits on individual outcomes were related to the number of home visits received . Among women living with HIV , intervention mothers were more likely to implement the PMTCT regimens , use condoms during all sexual episodes ( OR = 1.25 ; p = 0.014 ) , have infants with healthy weight-for-age measurements ( OR = 1.42 ; p = 0.045 ) , height-for-age measurements ( OR = 1.13 , p<0.001 ) , breastfeed exclusively for six months ( OR = 3.59 ; p<0.001 ) , and breastfeed longer ( OR = 3.08 ; p<0.001 ) . Number of visits was positively associated with infant birth weight ≥2500 grams ( OR = 1.07 ; p = 0.012 ) , healthy head-circumference-for-age measurements at 6 months ( OR = 1.09 , p = 0.017 ) , and improved cognitive development at 18 months ( OR = 1.02 , p = 0.048 ) . Conclusions Home visits to neighbourhood mothers by CHWs may be a feasible strategy for enhancing maternal/child outcomes . However , visits likely must extend over several years for persistent benefits . Trial Registration Clinical Trials.gov Background In Pakistan , only 59 - 73 % of children 12 - 23 months of age are fully immunized . This r and omized , controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates . Methods Three hundred and sixty-six mother-infant pairs , with infants aged ≤ 6 weeks , were enrolled and r and omized into either the intervention or control arm between August - November 2008 . The intervention , administered by trained community health workers , consisted of three targeted pictorial messages regarding vaccines . The control group received general health promotion messages based on Pakistan 's Lady Health Worker program curriculum . Assessment of DPT/Hepatitis B vaccine completion ( 3 doses ) was conducted 4-months after enrollment . A Poisson regression model was used to estimate effect of the intervention . The multivariable Poisson regression model included maternal education , paternal occupation , ownership of home , cooking fuel used at home , place of residence , the child 's immunization status at enrollment , and mother 's perception about the impact of immunization on child 's health . Results Baseline characteristics among the two groups were similar . At 4 month assessment , among 179 mother-infant pairs in the intervention group , 129 ( 72.1 % ) had received all 3 doses of DPT/Hepatitis B vaccine  , whereas in the control group 92/178 ( 51.7 % ) had received all 3 doses . Multivariable analysis revealed a significant improvement of 39 % ( adjusted RR = 1.39 ; 95 % CI : 1.06 - 1.81 ) in DPT-3/Hepatitis B completion rates in the intervention group . Conclusion A simple educational intervention design ed for low-literate population s , improved DPT-3/Hepatitis B vaccine completion rates by 39 % . These findings have important implication s for improving routine immunization rates in Pakistan Background This study evaluated the effects on healthcare access inequities of an intervention exempting children under 5 years from user fees in Burkina Faso . Methods The design consisted of two complementary studies . The first was an interrupted time series ( 56 months before and 12 months after ) study of daily curative consultations according to distance ( < 5 , 5–9 and ≥10 km ) in a stratified r and om sample of 18 health centres : 12 with the intervention and 6 without . The second was a  household panel survey ( n=1214 ) assessing the evolution of health-seeking behaviours . Multilevel regression was used throughout . Results Attendance doubled under the intervention , after adjusting for Centres de Santé et de Promotion Sociale size , districts , secular trend and seasonal variation . Utilisation increased for all distance ranges and in all of the 12 health centres of the intervention area . The exemption benefited all children ( rate ratios (RR)=1.52 ( 1.23 to 1.88 ) ) , whether their health needs were high ( RR=1.69 ( 1.22 to 2.32 ) ) or not ( RR=1.46 ( 1.10 to 1.93 ) ) and whether the children lived near ( RR=1.42 ( 1.09 to 1.85 ) ) or far from a health centre ( RR=1.79 ( 1.31 to 2.43 ) ) . The exemption benefited the children of poor families when health need was high and services near ( RR=5.23 ; ( 1.30 to 20.99 ) ) . The amount saved for a child 's treatment by the exemption was on average and median 2500 F CFA ( ≈US$5 ) . Conclusions Exempting children under five from user fees is effective and helps reduce inequities of access . It benefits vulnerable population s , although their service utilisation remains constrained by limitations in geographic accessibility of services Background Intermittent preventive treatment of malaria in children ( IPTc ) involves the administration of a course of anti-malarial drugs at specified time intervals to children at risk of malaria regardless of whether or not they are known to be infected .  IPTc provides a high level of protection against uncomplicated and severe malaria , with monthly sulphadoxine-pyrimethamine plus amodiaquine ( SP&AQ ) and sulphadoxine-pyrimethamine plus piperaquine being the most efficacious regimens . A key challenge is the identification of a cost-effective delivery strategy . Methods A community r and omized trial was undertaken in Jasikan district , Ghana to assess IPTc effectiveness and costs using SP&AQ delivered in three different ways . Twelve villages were r and omly selected to receive IPTc from village health workers ( VHWs ) or facility-based nurses working at health centres ' outpatient departments ( OPD ) or EPI outreach clinics . Children aged 3 to 59 months-old received one IPT course ( three doses ) in May , June , September and October . Effectiveness was measured in terms of children covered and adherent to a course and delivery costs were calculated in financial and economic terms using an ingredient approach from the provider perspective . Results The economic cost per child receiving at least the first dose of all 4 courses was US$ 4.58 when IPTc was delivered by VHWs , US$ 4.93 by OPD nurses and US$ 5.65 by EPI nurses . The unit economic cost of receiving all 3 doses of all 4 courses was US$ 7.56 and US$ 8.51 when IPTc was delivered by VHWs or facility-based nurses respectively . The main cost driver for the VHW delivery was supervision , reflecting re sources used for travelling to more remote communities rather than more intense supervision , and for OPD and EPI delivery , it was the opportunity cost of the time spent by nurses in dispensing IPTc . Conclusions VHWs achieve higher IPTc coverage and adherence at lower costs than facility-based nurses in Jasikan district , Ghana . Trial Registration Clinical Trials.gov NCT00119132 Objective To determine the effect of implementation of the Integrated Management of Neonatal and Childhood Illness strategy on treatment seeking practice s and on  neonatal and infant morbidity .  Design Cluster r and omised trial . Setting Haryana , India . Participants 29 667 births in nine intervention clusters and 30 813 births in nine control clusters . Main outcome measures The pre-specified outcome was the effect on treatment seeking practice s. Post hoc exploratory analyses assessed morbidity , hospital admission , post-neonatal infant care , and nutritional status outcomes . Interventions The Integrated Management of Neonatal and Childhood Illness intervention included home visits by community health workers , improved case management of sick children , and strengthening of health systems . Outcomes were ascertained through interviews with r and omly selected caregivers : 6204 , 3073 , and 2045 in intervention clusters and 6163 , 3048 , and 2017 in control clusters at ages 29 days , 6 months , and 12 months , respectively . Results In the intervention cluster , treatment was sought more often from an appropriate provider for severe neonatal illness ( risk ratio 1.76 , 95 % confidence interval 1.38 to 2.24 ) , for local neonatal infection ( 4.86 , 3.80 to 6.21 ) , and for diarrhoea at 6 months ( 1.96 , 1.38 to 2.79 ) and 12 months ( 1.22 , 1.06 to 1.42 ) and pneumonia at 6 months ( 2.09 , 1.31 to 3.33 ) and 12 months ( 1.44 , 1.00 to 2.08 ) . Intervention mothers reported fewer episodes of severe neonatal illness ( risk ratio 0.82 , 0.67 to 0.99 ) and lower prevalence of diarrhoea ( 0.71 , 0.60 to 0.83 ) and pneumonia ( 0.73 , 0.52 to 1.04 ) in the two weeks preceding the 6 month interview and of diarrhoea ( 0.63 , 0.49 to 0.80 ) and pneumonia ( 0.60 , 0.46 to 0.78 ) in the two weeks preceding the 12 month interview . Infants in the intervention clusters were more likely to still be exclusively breast fed in the sixth month of life ( risk ratio 3.19 , 2.67 to 3.81 ) . Conclusion Implementation of the Integrated Management of Neonatal and Childhood Illness programme was associated with timely treatment seeking from appropriate providers and reduced morbidity , a likely explanation for the reduction in mortality observed following implementation of the programme in this study . Trial registration Clinical trials NCT00474981 ; ICMR Clinical Trial Registry CTRI/2009/091/000715 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 neon 
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Supply side interventions included : delivery of services at or closer to home and service level improvements ( eg .
Interventions that delivered services at or closer to home and text messages were in general associated with a significant improvement in relevant outcomes .
Conclusions This review fills a gap in the literature by providing evidence of the range and effectiveness of interventions that can be used to increase access for children aged ≤5 years in LMIC .
It highlights some intervention areas that seem to show encouraging trends including text message reminders and delivery of services at or close to home .