***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 Pakistan has high maternal mortality , particularly in the rural areas . The delay in decision making to seek medical care during obstetric emergencies remains a significant factor in maternal mortality . Methods We present results from an experimental study in rural Pakistan . Village clusters were r and omly assigned to intervention and control arms ( 16 clusters each ) . In the intervention clusters , women were provided information on safe motherhood through pictorial booklets and audiocassettes ; traditional birth attendants were trained in clean delivery and recognition of obstetric and newborn complications ; and emergency transportation systems were set up . In eight of the 16 intervention clusters , husb and s also received specially design ed education material s on safe motherhood and family planning . Pre- and post-intervention surveys on selected maternal and neonatal health indicators were conducted in all 32 clusters . A district-wide survey was conducted two years after project completion to measure any residual impact of the interventions . Results Pregnant women in intervention clusters received  prenatal care and prophylactic iron therapy  more frequently than pregnant women in control clusters . Providing safe motherhood education to husb and s result ed in further improvement of some indicators . There was a small but significant increase in percent of hospital deliveries but no impact on the use of skilled birth attendants . Perinatal mortality reduced significantly in clusters where only wives received information and education in safe motherhood . The survey to assess residual impact showed similar results . Conclusions We conclude that providing safe motherhood education increased the probability of pregnant women  having prenatal care and utilization of health services for obstetric complications Abstract Objective To evaluate whether routine administration of sublingual misoprostol 600 μg after delivery reduces postpartum haemorrhage . Design R and omised double blind placebo controlled trial . Setting Primary health centre in Bissau , Guinea-Bissau , West Africa . Participants 661 women undergoing vaginal delivery . Intervention Misoprostol 600 μg or placebo administered sublingually immediately after delivery . Main outcome measures Postpartum haemorrhage , defined as a loss of ≥ 500 ml and decrease in haemoglobin concentration after delivery . Results The incidence of postpartum haemorrhage was not significantly different between the two groups , the relative risk being 0.89 ( 95 % confidence interval 0.76 to 1.04 ) in the misoprostol group compared with the placebo  group . Mean blood loss was 10.5 % ( −0.5 % to 20.4 % ) lower in the misoprostol group than in the control group . Severe postpartum haemorrhage of ≥ 1000 ml or ≥1500 ml occurred in 17 % ( 56 ) and 8 % ( 25 ) in the placebo group and 11 % ( 37 ) and 2 % ( 7 ) in the misoprostol group . Significantly fewer women in the misoprostol group experienced a loss of ≥1000 ml ( 0.66 , 0.45 to 0.98 ) or ≥ 1500 ml ( 0.28 , 0.12 to 0.64 ) . The decrease in haemoglobin concentration tended to be less in the misoprostol group , the mean difference between the two groups being 0.16 mmol/l ( −0.01 mmol/l to 0.32 mmol/l ) . Conclusion Sublingual misoprostol  reduces the frequency of severe postpartum haemorrhage 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 WHO recommends that anthelmintic treatment be included in strategies to improve maternal nutrition in areas where hookworms are endemic and anaemia is prevalent . At present , few countries have adopted this recommendation , partly owing to the lack of data to support the adverse effects of hookworms on maternal health . A longitudinal study was conducted on 125 women in Sierra Leone ( in 1995/96 ) to measure the impact of single-dose albendazole ( 400 mg ) and daily iron-folate supplements ( 36 mg iron and 5 mg folate ) on haemoglobin and serum ferritin concentration during pregnancy . Women who received both albendazole and iron-folate supplements experienced no significant change ( P > 0.05 ) in the prevalence of anaemia and iron-deficiency anaemia between the first and third trimesters . These prevalence levels significantly increased ( P < 0.05 ) in women who received either albendazole or iron-folate supplements or neither . After controlling for baseline haemoglobin concentration and season , the mean decline in haemoglobin concentration between the first and third trimester in women who received albendazole was 6.6 g/L less than in women who received the control ( P = 0.0034 ) . The corresponding value for iron-folate supplements was 13.7 g/L haemoglobin ( P < 0.001 ) . The effects of albendazole and iron-folate supplements  were additive . These findings lend support to WHO 's recommendation for anthelmintic treatment during pregnancy BACKGROUND More than 95 % of neonatal deaths occur in developing countries , approximately 50 % at home . Few data are available on the impact of h and -washing practice s by birth attendants or caretakers on  neonatal mortality . OBJECTIVE To evaluate the relationship between birth attendant and maternal h and -washing practice s and  neonatal mortality  in rural Nepal . DESIGN Observational prospect i ve cohort study . SETTING Sarlahi District in rural southern Nepal . PARTICIPANTS Newborn infants were originally enrolled in a community-based trial assessing the effect of skin and /or umbilical cord cleansing with chlorhexidine on neonatal mortality in southern Nepal . A total of 23,662 newborns were enrolled and observed through 28 days of life . MAIN EXPOSURES Question naires were administered to mothers on days 1 and 14 after delivery to identify care practice s and risk factors for mortality and infection . Three h and -washing categories were defined : ( 1 ) birth attendant h and washing with soap and water before assisting with delivery , ( 2 ) maternal h and washing with soap and water or antiseptic before h and ling the baby , and ( 3 ) combined birth attendant and maternal h and washing . OUTCOME MEASURES Mortality within the neonatal period . RESULTS Birth attendant h and washing was related to a statistically significant lower mortality rate among neonates ( adjusted relative risk [ RR ] = 0.81 ; 95 % confidence interval [ CI ] , 0.66 - 0.99 ) , as was maternal h and washing ( adjusted RR = 0.56 ; 95 % CI , 0.38 - 0.82 ) . There was a 41 % lower mortality rate among neonates exposed to both h and -washing practice s ( adjusted RR = 0.59 ; 95 % CI , 0.37 - 0.94 ) . CONCLUSIONS Birth attendant and maternal h and washing with soap and water were associated with significantly lower rates of neonatal mortality . Measures to improve or promote birth attendant and maternal h and washing could improve neonatal survival rates OBJECTIVES To determine the effectiveness of birth plans in increasing use of skilled care at delivery and in the postnatal period among antenatal care ( ANC ) attendees in a rural district with low occupancy of health units for delivery but high antenatal care uptake in northern Tanzania . METHODS Cluster r and omised trial in Ngorongoro district , Arusha region , involving 16 health units ( 8 per arm ) . Nine hundred and five pregnant women at 24 weeks of gestation and above ( 404 in the intervention arm ) were recruited and followed up to at least 1 month postpartum . RESULTS Skilled delivery care uptake was 16.8 % higher in the intervention units than in the control [ 95 % CI 2.6 - 31.0 ; P = 0.02 ] . Postnatal care utilisation in the first month of delivery was higher ( difference in proportions : 30.0 % [ 95 % CI 1.3 - 47.7 ; P < 0.01 ] ) and also initiated earlier ( mean duration 6.6 ± 1.7 days vs. 20.9 ± 4.4 days , P < 0.01 ) in the intervention than in the control arm . Women 's and providers ' reports of care satisfaction ( received or provided ) did not differ greatly between the two arms of the study ( difference in proportion : 12.1 % [ 95 % CI -6.3 - 30.5 ] P = 0.17 and 6.9 % [ 95 % CI -3.2 - 17.1 ] P = 0.15 , respectively ) . CONCLUSION Implementation of birth plans during ANC can increase the uptake of skilled delivery and post delivery care in the study district without negatively affecting women 's and providers ' satisfaction with available ANC services . Birth plans should be considered along with the range of other recommended interventions as a strategy to improve the uptake of maternal health services 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 Background In the global context of a reduction of under-five mortality , neonatal mortality is an increasingly relevant component of this mortality . Malaria in pregnancy may affect neonatal survival , though no strong evidence exists to support this association . Methods In the context of a r and omised , placebo-controlled trial of intermittent preventive treatment ( IPTp ) with sulphadoxine-pyrimethamine ( SP ) in 1030 Mozambican pregnant women , 997 newborns were followed up until 12 months of age . There were 500 live borns to women who received placebo  and 497 to those who received SP . Findings There were 58 infant deaths ; 60.4 % occurred in children born to women who received placebo and 39.6 % to women who received IPTp ( p = 0.136 ) . There were 25 neonatal deaths ; 72 % occurred in the placebo group and 28 % in the IPTp group ( p = 0.041 ) . Of the 20 deaths that occurred in the first week of life , 75 % were babies born to women in the placebo group and 25 % to those in the IPTp group ( p = 0.039 ) . IPTp reduced neonatal mortality by 61.3 % ( 95 % CI 7.4 % , 83.8 % ) ; p = 0.024 ] . Conclusions Malaria prevention with SP in pregnancy can reduce neonatal mortality . Mechanisms associated with increased malaria infection at the end of pregnancy may explain the excess mortality in the malaria less protected group . Alternatively , SP may have reduced the risk of neonatal infections . These findings are of relevance to promote the implementation of IPTp with SP , and provide insights into the underst and ing of the pathophysiological mechanisms through which maternal malaria affects fetal and neonatal health . Trial Registration Clinical Trials.gov 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 
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RESULTS In the aggregate , achieving high effective coverage for this set of interventions would very substantially reduce risk for our outcomes of interest and reduce outcome inequities .
Behavioral interventions targeting practice s at birth and in the hours that follow can have substantial impact in setting s where many births happen at home : in such circumstances early initiation of breastfeeding can reduce risk of newborn death by up to 20 % ; good thermal care practice s can reduce mortality risk by a similar order of magnitude .
Simple interventions delivered during pregnancy have considerable potential impact on important mortality outcomes .