***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 Background : Challenges to retention in prenatal care seem to exist under both universal systems of care , as in Canada , and non-universal systems of care , as in the United States . However , among population s being served by a system of publicly funded health care , the barriers are less well understood and universal uptake of prenatal services has not been realized . Determining the characteristics of women who dropped out of a prenatal care r and omized controlled trial can help identify those who may need alternate retention and service approaches . Methods : In this study , pregnant women were r and omized to : a ) current st and ard of care ; b ) ' a ' plus nursing support ; or c ) ' b ' plus a paraprofessional home visitor . 16 % of 2,015 women did not complete all three telephone interviews ( 197 dropped out and 124 became unreachable ) . Responders were compared to non-responders on demographics , lifestyle , psychosocial factors , and life events using chi-squared tests . Logistic regression models were constructed using stepwise logistic regression to determine the probability of not completing the prenatal program . Results : Completion rates did not differ by intervention . In comparison to responders , non-responders were more likely to be younger , less educated , have lower incomes , smoke , have low social support , have a history of depression , and have separated or divorced parents ( all p < 0.05 ) . Unreachable women were more likely to be single , use drugs , report distress and adverse life events ( all p < 0.05 ) . Non-Caucasian women were more likely to drop out ( p = 0.002 ) . Logistic regression modeling indicated that independent key risk factors for dropping out were : less than high school education , separated or divorced parents , lower social support , and being non-Caucasian . Pregnant women who were single/separated/divorced , less than 25 years old , had less than high school education , earned less than $ 40,000 in annual household income , and /or smoked had greater odds of becoming unreachable at some point during pregnancy and not completing the study . Conclusion : Women at risk due to lifestyle and challenging circumstances were difficult to retain in a prenatal care study , regardless of the intervention . For women with complex health , lifestyle and social issues , lack of retention may reflect incongruence between their needs and the program . Trial registration : Current Controlled Trials IS RCT Background In Sub-Saharan Africa over one million newborns die annually . We developed a sustainable and scalable home-based counselling intervention for delivery by community volunteers in rural southern Tanzania to improve newborn care practice s and survival . Here we report the effect on newborn care practice s one year after full implementation . Methods All 132 wards in the 6-district study area were r and omised to intervention or comparison groups . Starting in 2010 , in intervention areas trained volunteers made home visits during pregnancy and after childbirth to promote recommended newborn care practice s including hygiene , breastfeeding and identification and extra care for low birth weight babies . In 2011 , in a representative sample of 5,240 households , we asked women who had given birth in the previous year both about counselling visits and their childbirth and newborn care practice s. Results Four of 14 newborn care practice s were more commonly reported in intervention than comparison areas : delaying the baby ’s first bath by at least six hours ( 81 % versus 68 % , OR 2.0 ( 95 % CI 1.2 - 3.4 ) ) , exclusive breastfeeding in the three days after birth ( 83 % versus 71 % , OR 1.9 ( 95 % CI 1.3 - 2.9 ) ) , putting nothing on the cord ( 87 % versus 70 % , OR 2.8 ( 95 % CI 1.7 - 4.6 ) ) , and , for home births , tying the cord with a clean thread ( 69 % versus 39 % , OR 3.4 ( 95 % CI 1.5 - 7.5 ) ) . For other behaviours there was little evidence of differences in reported practice s between intervention and comparison areas including childbirth in a health facility or with a skilled attendant , thermal care practice s , breastfeeding within an hour of birth and , for home births , the birth attendant having clean h and s , cutting the cord with a clean blade and birth preparedness activities . Conclusions A home-based counselling strategy using volunteers and design ed for scale-up can improve newborn care behaviours in rural communities of southern Tanzania . Further research is needed to evaluate if , and at what cost , these gains will lead to improved newborn survival . Trial registration Trial Registration Number NCT01022788 ( http://www . clinical trials.gov , 2009 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 Maternal health services continue to favour the wealthiest in lower and middle income countries . Debate about the potential of performance-based financing ( PBF ) to address these disparities continues . As PBF is adopted by countries , it is critical to underst and the equity effects for maternal services . The aim of this study is to examine the effects of PBF on equity in maternal health service use when no specific provisions target the poorest in the population . In Rw and a , PBF was design ed to increase health service use , which was universally low . Paired districts were r and omly assigned to intervention and control for PBF implementation . Using Rw and a 's Demographic Health Survey data from 2005 ( pre-intervention ) and 2007 - 8 ( post-intervention ) , a cluster-level panel data set of 7899 women 15 - 49 years of age from intervention ( 4477 ) and control districts ( 3422 ) was created . The impact of PBF on reported use of facility deliveries , antenatal care ( ANC ) and modern contraceptive use was estimated using a difference-in-differences model with community fixed effects . Interaction terms between wealth quintiles and PBF were estimated to identify the differential effect of PBF among poorer women . The probability of a facility delivery increased by 10 percentage points in the intervention when compared with the control districts ( P = 0.014 ) , while no significant effects were noted for ANC visits or modern contraceptive use . Service use increased for intervention and control population s and across all wealth quintiles from 2005 to 2007 , with no evidence that PBF was a pro-poor or a pro-rich strategy . Insurance remained a positive predictor of service use . This research suggests that if service use is uniformly low then a PBF programme that incentivizes select services , such as facility deliveries , may improve service use overall . However , if the equity gap is extreme , then a PBF programme without equity targets will do little to alleviate disparities 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 OBJECTIVES To evaluate the impact of Oportunidades , a large-scale , conditional cash transfer programme in Mexico , on  birthweight .  The programme provides cash transfers to low-income , rural households in Mexico , conditional on accepting nutritional supplements health education , and health care . METHODS The primary analyses used retrospective reports from 840 women in poor rural communities participating in an effectiveness study and r and omly assigned to incorporation into the programme in 1998 or 1999 across seven Mexican states . Pregnant women in participating households received nutrition supplements and health care , and accepted cash transfers . Using multivariate and instrumental variable analyses , we estimated the impact of the programme on birthweight in grams and low birthweight ( < 2500 g ) , receipt of any pre-natal care , and number of pre-natal visits . RESULTS Oportunidades beneficiary status was associated with 127.3 g higher birthweight among participating women and a 4.6 percentage point reduction in low birthweight . CONCLUSION The Oportunidades conditional cash transfer programme improved birthweight outcomes . This finding is relevant to countries implementing conditional cash transfer programmes 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 
    Output:
    
Authors ' conclusions Implication s for practice - Single interventions may improve ANC coverage ( at least one visit and four or more visits ) and deliveries in health facilities .
Combined interventions may improve ANC coverage ( at least one visit ) , reduce perinatal mortality and reduce the occurrence of low birthweight .
Almost half of pregnant women worldwide miss out on this level of care , and this is more problematic in low- and middle-income countries .
Trials comparing one intervention with no intervention Single interventions only marginally improved the numbers of women attending four antenatal visits ( high quality ) .
Trials comparing two or more interventions with no intervention Combined interventions did not improve the number of women with four or more visits ( low quality ) , or reduce maternal deaths ( moderate quality ) .
Nor did it increase the number of women who delivered in a health facility ( moderate quality ) .
We found no evidence that trials of community interventions worked differently from trials of health systems interventions .
Trials comparing one intervention with a combination of interventions - There was no difference in the number of women attending four or more antenatal visits ( and at least one visit ) , maternal deaths , baby deaths , the number of deliveries in a health facility or the number of women who received intermittent preventive treatment for malaria .
What does this mean ?
Single interventions may improve antenatal care