***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 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 The “ Health for All Project ” ( HFAP ) policy in Nigeria was complemented by the National Drug Policy to ensure constant availability of high quality drugs and medical consumables at affordable prices to citizens in public hospitals . Apart from strengthening the utilization of health services , the project also sought to improve health care delivery for the poor who could not afford the high cost of drugs in private clinics and pharmaceutical stores . Employing a survey method with stratified and systematic r and om techniques , the study found failed expectations in the promises of HFAP policy among the 1250 low-income women in Uyo urban . In the face of “ stock out ” where most drugs , pharmaceuticals , and medical supplies are consistently not available for dispensing in public hospitals and health centers poor urban women resorted to alternative health care in prayer houses , herbal homes , patent medicine vendors , health workers homes , and traditional birth attendants . The study reported that stock out in government health facilities result ed in health hazards and the relapse of illnesses as a result of non-adherence to treatment regime and exposure to fake , expired , and adulterated drugs . A renewed commitment in health care delivery in Nigeria is called for if poor women are to be really empowered BACKGROUND Community mobilisation through participatory women 's groups might improve birth outcomes in poor rural communities . We therefore assessed this approach in a largely tribal and rural population in three districts in eastern India . METHODS From 36 clusters in Jharkh and and Orissa , with an estimated population of 228 186 , we assigned 18 clusters to intervention or control using stratified r and omisation . Women were eligible to participate if they were aged 15 - 49 years , residing in the project area , and had given birth during the study . In intervention clusters , a facilitator convened 13 groups every month to support participatory action and learning for women , and facilitated the development and implementation of strategies to address maternal and newborn health problems . The primary outcomes were reductions in neonatal mortality rate ( NMR ) and maternal depression scores . Analysis was by intention to treat . This trial is registered as an International St and ard R and omised Controlled Trial , number IS RCT N21817853 . FINDINGS After baseline surveillance of 4692 births , we monitored outcomes for 19 030 births during 3 years ( 2005 - 08 ) . NMRs per 1000 were 55.6 , 37.1 , and 36.3 during the first , second , and third years , respectively , in intervention clusters , and 53.4 , 59.6 , and 64.3 , respectively , in control clusters . NMR was 32 % lower in intervention clusters adjusted for clustering , stratification , and baseline differences ( odds ratio 0.68 , 95 % CI 0.59 - 0.78 ) during the 3 years , and 45 % lower in years 2 and 3 ( 0.55 , 0.46 - 0.66 ) . Although we did not note a significant effect on maternal depression overall , reduction in moderate depression was 57 % in year 3 ( 0.43 , 0.23 - 0.80 ) . INTERPRETATION This intervention could be used with or as a potential alternative to health-worker-led interventions , and presents new opportunities for policy makers to improve maternal and newborn health outcomes in poor population s. FUNDING Health Foundation , UK Department for International Development , Wellcome Trust , and the Big Lottery Fund ( UK ) Background Globally , puerperal sepsis accounts for an estimated 8–12 % of maternal deaths , but evidence is lacking on the extent to which clean delivery practice s could improve maternal survival . We used data from the control arms of four cluster-r and omised controlled trials conducted in rural India , Bangladesh and Nepal , to examine associations between clean delivery kit use and h and washing  by the birth attendant with maternal mortality among home deliveries . Methods We tested associations between  clean delivery practice s and maternal deaths , using a pooled data set for 40,602 home births across sites in the three countries . Cross-sectional data were analysed by fitting logistic regression models with and without multiple imputation , and confounders were selected a priori using causal directed acyclic graphs . The robustness of estimates was investigated through sensitivity analyses . Results H and washing was associated with a 49 % reduction in the odds of maternal mortality after adjusting for confounding factors ( adjusted odds ratio ( AOR ) 0.51 , 95 % CI 0.28–0.93 ) . The sensitivity analysis testing the missing at r and om assumption for the multiple imputation , as well as the sensitivity analysis accounting for possible misclassification bias in the use of clean delivery practice s , indicated that the association between h and washing and maternal death had been over estimated . Clean delivery kit use was not associated with a maternal death ( AOR 1.26 , 95 % CI 0.62–2.56 ) . Conclusions Our evidence suggests that h and washing in delivery is critical for maternal survival  among home deliveries in rural South Asia , although the exact magnitude of this effect is uncertain due to inherent biases associated with observational data from low re source setting s. Our findings indicating kit use does not improve maternal survival , suggests that the soap is not being used in all instances that kit use is being reported Introduction Mother-to-child transmission of HIV can be reduced to<5 % with appropriate antiretroviral medications . Such reductions depend on multiple health system encounters during antenatal care ( ANC ) , delivery and breastfeeding ; in countries with limited access to care , transmission remains high . In Lesotho , where 28 % of women attending ANC are HIV positive but where geographic and other factors limit access to ANC and facility deliveries , a Minimum PMTCT Package was launched in 2007 as an alternative to the existing facility-based approach . Distributed at the first ANC visit , it packaged together all necessary pregnancy , delivery and early postnatal antiretroviral medications for mother and infant . Methods To examine the availability , feasibility , acceptability and possible negative consequences of the Minimum PMTCT Package , data from a 2009 qualitative and quantitative study and a 2010 facility assessment were used . To examine the effects on ANC and facility-based delivery rates , a difference-in-differences analytic approach was applied to 2009 Demographic and Health Survey data for HIV-tested women who gave birth before and after Minimum PMTCT Package implementation . Results The Minimum PMTCT Package was feasible and acceptable to providers and clients . Problems with test kit and medicine stock-outs occurred , and 46 % of women did not receive the Minimum PMTCT Package until at least their second ANC visit . Providing adequate instruction on the use of multiple medications represented a challenge . The proportion of HIV-positive women delivering in facilities declined after Minimum PMTCT Package implementation , although it increased among HIV-negative women ( difference-in-differences=14.5 % , p=0.05 ) . The mean number of ANC visits declined more among HIV-positive women than among HIV-negative women after implementation , though the difference was not statistically significant ( p=0.09 ) . Changes in the percentage of women receiving≥4 ANC visits did not differ between the two groups . Conclusions If supply issues can be resolved and adequate client educational material s provided , take-away co-packages have the potential to increase access to PMTCT commodities in countries where women have limited access to health services . However , efforts must be made to carefully monitor potential changes in ANC visits and facility deliveries , and further evaluation of adherence , safety and effectiveness are needed BACKGROUND There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year . There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries . METHODS We performed a cluster-r and omized , controlled trial involving seven subdistricts ( talukas ) of a rural district in Pakistan . In three talukas r and omly assigned to the intervention group , traditional birth attendants were trained and issued disposable delivery kits ; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes ; and obstetrical teams provided outreach clinics for antenatal care . Women in the four control talukas received usual care . The primary outcome measures were perinatal and maternal mortality . RESULTS Of the estimated number of eligible women in the seven talukas , 10,114 ( 84.3 percent ) were recruited in the three intervention talukas , and 9443 ( 78.7 percent ) in the four control talukas . In the intervention group , 9184 women ( 90.8 percent ) received antenatal care by trained traditional birth attendants , 1634 women ( 16.2 percent ) were seen antenatally at least once by the obstetrical teams , and 8172 safe-delivery kits were used . As compared with the control talukas , the intervention talukas had a cluster-adjusted odds ratio for perinatal death of 0.70 ( 95 percent confidence interval , 0.59 to 0.82 ) and for maternal mortality of 0.74 ( 95 percent confidence interval , 0.45 to 1.23 ) . CONCLUSIONS Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality . This model could result in large improvements in perinatal and maternal health in developing countries OBJECTIVE To determine the feasibility and acceptability of providing clean birth kits ( CBKs ) containing misoprostol for self-administration in a rural setting in Papua New Guinea . METHODS A prospect i ve intervention study was conducted between April 8 , 2013 , and October 24 , 2014 . Eligible participants were women in the third trimester of pregnancy who attended a prenatal clinic in Unggai Bena . Participants received individual instruction and were then given a CBK containing 600μg misoprostol tablets for self-administration following an unsupervised birth if they could demonstrate their underst and ing of correct use of items in the CBK . Data regarding the use and acceptability of the CBK and misoprostol were collected during postpartum follow-up . RESULTS Among 200 participants , 106 ( 53.0 % ) had an unsupervised birth , and 99 ( 93.4 % ) of these women used the CBK . All would use the CBK again and would recommend it to others . Among these 99 women , misoprostol was self-administered by 98 ( 99.0 % ) , all of whom would take the drug again and would recommend it to others . CONCLUSION The findings strengthen the case for community-based use of misoprostol to prevent postpartum hemorrhage in remote communities . Large-scale interventions should be planned to further evaluate impact and acceptability 
    Output:
    
Conclusion This review suggests potential benefits in the use of supply kits to improve maternal and neonatal health .