***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 Around a quarter of the world 's neonatal and maternal deaths occur in India . Morbidity and mortality are highest in rural areas and among the poorest wealth quintiles . Few interventions to improve maternal and newborn health outcomes with government-m and ated community health workers have been rigorously evaluated at scale in this setting .The study aims to assess the impact of a community mobilisation intervention with women 's groups facilitated by ASHAs to improve maternal and newborn health outcomes among rural tribal communities of Jharkh and and Orissa . Methods / design The study is a cluster-r and omised controlled trial and will be implemented in five districts , three in Jharkh and and two in Orissa . The unit of r and omisation is a rural cluster of approximately 5000 population . We identified villages within rural , tribal areas of five districts , approached them for participation in the study and enrolled them into 30 clusters , with approximately 10 ASHAs per cluster . Within each district , 6 clusters were r and omly allocated to receive the community intervention or to the control group , result ing in 15 intervention and 15 control clusters . R and omisation was carried out in the presence of local stakeholders who selected the cluster numbers and allocated them to intervention or control using a pre-generated r and om number sequence . The intervention is a participatory learning and action cycle where ASHAs support community women 's groups through a four-phase process in which they identify and prioritise local maternal and newborn health problems , implement strategies to address these and evaluate the result . The cycle is design ed to fit with the ASHAs ' m and ate to mobilise communities for health and to complement their other tasks , including increasing institutional delivery rates and providing home visits to mothers and newborns . The trial 's primary endpoint is neonatal mortality during 24 months of intervention . Additional endpoints include home care practice s and health care-seeking in the antenatal , delivery and postnatal period . The impact of the intervention will be measured through a prospect i ve surveillance system implemented by the project team , through which mothers will be interviewed around six weeks after delivery . Cost data and qualitative data are collected for cost-effectiveness and process evaluations . Study registration IS RCT N : IS RCT Background Maternal , perinatal and neonatal mortality remains high in low-income countries . We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi . Methods We evaluated a rural participatory women ’s group community intervention ( CI ) and a quality improvement intervention at health centres ( FI ) via a two-by-two factorial cluster r and omized controlled trial . Consenting pregnant women were followed-up to 2 months after birth using key informants . Primary outcomes were maternal , perinatal and neonatal mortality . Clusters were health centre catchment areas assigned using stratified computer-generated r and omization . Following exclusions , including non-birthing facilities , 61 clusters were analysed : control ( 17 clusters , 4912 births ) , FI ( 15 , 5335 ) , CI ( 15 , 5080 ) and FI + CI ( 14 , 5249 ) . This trial was registered as International St and ard R and omised Controlled Trial [ IS RCT N18073903 ] . Outcomes for 14 576 and 20 576 births were recorded during baseline ( June 2007–September 2008 ) and intervention ( October 2008–December 2010 ) periods . Results For control , FI , CI and FI + CI clusters neonatal mortality rates were 34.0 , 28.3 , 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2 , 55.1 , 48.0 and 48.4 per 1000 births , during the intervention period . Adjusting for clustering and stratification , the neonatal mortality rate was 22 % lower in FI + CI than control clusters ( OR = 0.78 , 95 % CI 0.60–1.01 ) , and the perinatal mortality rate was 16 % lower in CI clusters ( OR = 0.84 , 95 % CI 0.72–0.97 ) . We did not observe any intervention effects on maternal mortality . Conclusions Despite implementation problems , a combined community and facility approach using participatory women ’s groups and quality improvement at health centres reduced newborn mortality in rural Malawi BACKGROUND Women 's groups and health education by peer counsellors can improve the health of mothers and children . We assessed their effects on mortality and breastfeeding rates  in rural Malawi . METHODS We did a 2 × 2 factorial , cluster-r and omised trial in 185,888 people in Mchinji district . 48 equal-sized clusters were r and omly allocated to four groups with a computer-generated number sequence . 24 facilitators guided groups through a community action cycle to tackle maternal and child health problems . 72 trained volunteer peer counsellors  made home visits at five timepoints during pregnancy and after birth to support breastfeeding and infant care . Primary outcomes for the women 's group intervention were maternal , perinatal , neonatal , and infant mortality rates ( MMR , PMR , NMR , and IMR , respectively ) ; and for the peer counselling were IMR and exclusive breastfeeding ( EBF ) rates . Analysis was by intention to treat . The trial is registered as IS RCT N06477126 . FINDINGS We monitored outcomes of 26,262 births between 2005 and 2009 . In a factorial model adjusted only for clustering and the volunteer peer counselling intervention , in women 's group areas , for years 2 and 3 , we noted non-significant decreases in NMR ( odds ratio 0.93 , 0.64 - 1.35 ) and MMR ( 0.54 , 0.28 - 1.04 ) . After adjustment for parity , socioeconomic quintile , and baseline measures , effects were larger for NMR ( 0.85 , 0.59 - 1.22 ) and MMR ( 0.48 , 0.26 - 0.91 ) . Because of the interaction between the two interventions , a stratified analysis was done . For women 's groups , in adjusted analyses , MMR fell by 74 % ( 0.26 , 0.10 - 0.70 ) , and NMR by 41 % ( 0.59 , 0.40 - 0.86 ) in areas with no peer counsellors , but there was no effect in areas with counsellors ( 1.09 , 0.40 - 2.98 , and 1.38 , 0.75 - 2.54 ) . Factorial analysis for the peer counselling intervention for years 1 - 3 showed a fall in IMR of 18 % ( 0.82 , 0.67 - 1.00 ) and an improvement in EBF rates ( 2.42 , 1.48 - 3.96 ) . The results of the stratified , adjusted analysis showed a 36 % reduction in IMR ( 0.64 , 0.48 - 0.85 ) but no effect on EBF ( 1.18 , 0.63 - 2.25 ) in areas without women 's groups , and in areas with women 's groups there was no effect on IMR ( 1.05 , 0.82 - 1.36 ) and an increase in EBF ( 5.02 , 2.67 - 9.44 ) . The cost of women 's groups was US$ 114 per year of life lost ( YLL ) averted and that of peer counsellors was $ 33 per YLL averted , using stratified data from single intervention comparisons . INTERPRETATION Community mobilisation through women 's groups and volunteer peer counsellor health education are methods to improve maternal and child health outcomes in poor rural population s in Africa . FUNDING Saving Newborn Lives , UK Department for International Development , and Wellcome Trust 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 Background Progress on neonatal survival has been slow in most countries . While there is evidence on what works to reduce newborn mortality , there is limited knowledge on how to deliver interventions effectively when health systems are weak . Cluster r and omized trials have shown strong reductions in neonatal mortality using community mobilisation with women 's groups in rural Nepal and India . A similar trial in Bangladesh showed no impact . A main hypothesis is that this negative finding is due to the much lower coverage of women 's groups in the intervention population in Bangladesh compared to India and Nepal . For evidence -based policy making it is important to examine if women 's group coverage is a main determinant of their impact . The study aims to test the effect on newborn and maternal health outcomes of a participatory women 's group intervention with a high population coverage of women 's groups . Methods A cluster r and omised trial of a participatory women 's group intervention will be conducted in 3 districts of rural Bangladesh . As we aim to study a women 's group intervention with high population coverage , the same 9 intervention and 9 control unions  will be used as in the 2005 - 2007 trial . These had been r and omly allocated using the districts as strata . To increase coverage , 648 new groups were formed in addition to the 162 existing groups that were part of the previous trial . An open cohort of women who are permanent residents in the union in which their delivery or death was identified , is enrolled . Women and their newborns are included after birth , or , if a woman dies during pregnancy , after her death . Excluded are women who are temporary residents in the union in which their birth or death was identified . The primary outcome is neonatal mortality in the last 24 months of the study . A low cost surveillance system will be used to record all birth outcomes and deaths to women of reproductive age in the study population . Data on home care practice s and health care use are collected through interviews . Trial registration IS RCT N : IS RCT Increased interest in the potential contribution of insecticide-impregnated bed nets ( ITBN ) to malaria control has led to research efforts to determine the impact and sustainability of ITBN programmes in differing environments . There is a need to develop effective , feasible educational strategies that will both inform and motivate community members , and thus maximize the correct usage of ITBN . This is especially true in communities where indigenous usage of bed nets is low . This paper describes the educational component of a r and omized controlled community intervention trial of ITBN , with childhood malaria morbidity as an outcome . The educational approach and messages for the ITBN trial were developed from anthropological survey data collected 4 years before the trial , and from community surveys conducted by project research ers . Low levels of underst and ing amongst mothers of the aetiological link between mosquitos and malaria led to the exclusion of the term ' malaria ' from the initial educational messages promoting the use of ITBN . Appropriate individuals within the existing district health care structure were trained as community educators in the project . These educators conducted intensive teaching in the community through public meetings and group teaching in the first 6 months of the trial . The impact of these initial activities was assessed through interviews with a r and om sample of 100 mothers and 50 household heads . This allowed the identification of messages which had not been well understood and further educational methods were chosen to address the areas pinpointed . The community assessment also demonstrated that , in 1994 , over 90 % of mothers understood a protective role for bed nets against malaria and the ITBN education messages were changed to take account of this . The school programme was evaluated through determining outreach ( 
    Output:
    
The review concluded that programs working collaboratively or achieving shared leadership with a community can lead to behavior change and cost-effective sustained transformation to improve critical health behaviors and reduce poor health outcomes in low- and middle-income countries .
Overall , community engagement is an understudied component of improving child outcomes