***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: A home visit intervention program for adolescents throughout their pregnancy and during the early stages of motherhood was evaluated . The participants ( N = 90 ) were part of a larger group of adolescents treated in two health centers in a poor neighborhood in Santiago , Chile . The program was carried out by volunteer community health monitors and evaluated through an experimental , r and omized , controlled clinical trial . Cost-effectiveness was examined in comparison with st and ard health care . Results show higher scores for the intervention group on the mothers ’ mental health and nutritional state , as well as on the children ’s levels of linguistic development Objective To assess the efficacy of an intervention design ed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances . Design R and omised controlled trial . Setting Khayelitsha , a peri-urban settlement in South Africa . Participants 449 pregnant women . Interventions The intervention was delivered from late pregnancy and for six months postpartum . Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting . The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother . Women in the control group received no therapeutic input from the research team . Main outcome measures Primary outcomes : quality of mother-infant interactions at six and 12 months postpartum ; infant attachment security at 18 months . Secondary outcome : maternal depression at six and 12 months . Results The intervention was associated with significant benefit to the mother-infant relationship . At both six and 12 months , compared with control mothers , mothers in the intervention group were significantly more sensitive ( 6 months : mean difference=0.77 ( SD 0.37 ) , t=2.10 , P<0.05 , d=0.24 ; 12 months : mean difference=0.42 ( 0.18 ) , t=−2.04 , P<0.05 , d=0.26 ) and less intrusive ( 6 months : mean difference=0.68 ( 0.36 ) , t=2.28 , P<0.05 , d=0.26 ; 12 months : mean difference=−1.76 ( 0.86 ) , t=2.28 , P<0.05 , d=0.24 ) in their interactions with their infants . The intervention was also associated with a higher rate of secure infant attachments at 18 months ( 116/156 ( 74 % ) v 102/162 ( 63 % ) ; Wald=4.74 , odds ratio=1.70 , P<0.05 ) . Although the prevalence of maternal depressive disorder was not significantly reduced , the intervention had a benefit in terms of maternal depressed mood at six months ( z=2.05 , P=0.04 ) on the Edinburgh postnatal depression scale ) . Conclusions The intervention , delivered by local lay women , had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment , factors known to predict favourable child development . If these effects persist , and if they are replicated , this intervention holds considerable promise for use in the developing world . Trial registration Current Controlled Trials IS RCT N25664149 BACKGROUND The optimum way to improve the recognition and treatment of postnatal depression in developing countries is uncertain . We compared the effectiveness of a multicomponent intervention with usual care to treat postnatal depression in low-income mothers in primary -care clinics in Santiago , Chile . METHODS 230 mothers with major depression attending postnatal clinics were r and omly allocated to either a multicomponent intervention ( n=114 ) or usual care ( n=116 ) . The multicomponent intervention involved a psychoeducational group , treatment adherence support , and pharmacotherapy if needed . Usual care included all services normally available in the clinics , including antidepressant drugs , brief psychotherapeutic interventions , medical consultations , or external referral for specialty treatment . The primary outcome measure was the Edinburgh postnatal depression scale ( EPDS ) score at 3 and 6 months after r and omisation . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , number NCT00518830 . FINDINGS 208 ( 90 % ) of women r and omly assigned to treatment groups completed assessment s. The crude mean EPDS score was lower for the multicomponent intervention group than for the usual care group at 3 months ( 8.5 [ 95 % CI 7.2 - 9.7 ] vs 12.8 [ 11.3 - 14.1 ] ) . Although these differences between groups decreased by 6 months , EPDS score remained better in multicomponent intervention group than in usual care group ( 10.9 [ 9.6 - 12.2 ] vs 12.5 [ 11.1 - 13.8 ] ) . The adjusted difference in mean EPDS between the two groups at 3 months was -4.5 ( 95 % CI -6.3 to -2.7 ; p<0.0001 ) . The decrease in the number of women taking antidepressants after 3 months was greater in the intervention group than in the usual care group ( multicomponent intervention from 60/101 [ 59 % ; 95 % CI 49 - 69 % ] to 38/106 [ 36 % ; 27 - 46 % ] ; usual care from 18/108 [ 17 % ; 10 - 25 % ] to 11/102 [ 11 % ; 6 - 19 % ] ) . INTERPRETATION Our findings suggest that low-income mothers with depression and who have newly born children could be effectively helped , even in low-income setting s , through multicomponent interventions . Further refinements to this intervention are needed to ensure treatment compliance after the acute phase 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 ) Summary Background The treatment of perinatal depression is a public-health priority because of its high prevalence and association with disability and poor infant development . We integrated a cognitive behaviour therapy-based intervention into the routine work of community-based primary health workers in rural Pakistan and assessed the effect of this intervention on  maternal depression and infant outcomes . Methods We r and omly assigned 40 Union Council clusters in rural Rawalpindi , Pakistan , in equal numbers to intervention or control . Married women ( aged 16–45 years ) in their third trimester of pregnancy with perinatal depression were eligible to participate . In the intervention group , primary health workers were trained to deliver the psychological intervention , whereas in the control group untrained health workers made an equal number of visits to the depressed mothers . The primary outcomes were infant weight and height at 6 months and 12 months , and secondary outcome was maternal depression . The interviewers were unaware of what group the participants were assigned to . Analysis was by intention to treat . The study is registered as IS RCT N65316374 . Findings The number of clusters per group was 20 , with 463 mothers in the intervention group and 440 in the control group . At 6 months , 97 ( 23 % ) of 418 and 211 ( 53 % ) of 400 mothers in the intervention and control groups , respectively , met the criteria for major depression ( adjusted odds ratio ( OR ) 0·22 , 95 % CI 0·14 to 0·36 , p<0·0001 ) . These effects were sustained at 12 months ( 111/412 [ 27 % ] vs 226/386 [ 59 % ] , adjusted OR 0·23 , 95 % CI 0·15 to 0·36 , p<0·0001 ) . The differences in weight-for-age and height-for-age Z scores for infants in the two groups were not significant at 6 months ( −0·83 vs −0·86 , p=0·7 and −2·03 vs −2·16 , p=0·3 , respectively ) or 12 months ( −0·64 vs −0·8 , p=0·3 and −1·10 vs −1·36 , p=0·07 , respectively ) . Interpretation This psychological intervention delivered by community-based primary health workers has the potential to be integrated into health systems in re source -poor setting s. Funding Wellcome Trust BACKGROUND  Postnatal depression ( PND ) is a serious public health problem in re source -limited countries . Research is limited on PND affecting HIV-infected women in sub-Saharan Africa . Zimbabwe has one of the highest antenatal HIV infection rates in the world . We determined the prevalence and risk factors of PND among women attending urban primary care clinics in Zimbabwe . METHODS Using trained peer counselors , a simple r and om sample of postpartum women ( n = 210 ) attending the 6-week postnatal visit at two urban primary care clinics were screened for PND using the Shona version of the Edinburgh Postnatal Depression Scale ( EPDS ) . All women were subsequently subjected to mental status examination using the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ) criteria for major depression by two psychiatrists who had no knowledge of the EPDS test results . RESULTS Of the 210 mothers ( 31 HIV positive , 148 HIV negative , 31 unknown status ) enrolled during the postpartum period , 64 ( 33 % ) met DSM-IV criteria for depression . The HIV prevalence was 14.8 % . Of the 31 HIV-infected mothers , 17(54 % ) met DSM-IV criteria for depression . Univariate analysis showed that multiparity ( prevalent odds ratio [ OR ] 2.22 , 95 % confidence intervals [ CI ] 1.15 - 4.31 ) , both parents deceased ( OR 2.35 , 95 % CI 1.01 - 5.45 ) , and having experienced a recent adverse life event ( OR 8.34 , CI 3.77 - 19.07 ) were significantly associated with PND . Multivariate analysis showed that PND was significantly associated with adverse life event ( OR 7.04 , 95 % CI 3.15 - 15.76 ) , being unemployed ( OR 3.12 , 95 % CI 1.23 - 7.88 ) , and multiparity ( OR 2.50 , 95 % CI 1.00 - 6.24 ) . CONCLUSIONS Our data indicate a high burden of PND among women in Zimbabwe . It is feasible to screen for PND in primary care clinics using peer counselors . Screening for PND and access to mental health interventions should be part of routine antenatal care for all women in Zimbabwe BACKGROUND Developing a sense of well-being and achieving maternal role competence are considered critical components of maternal adaptation . Given the growing evidence of postpartum depression and its devastating effects , effective childbirth psychoeducation programme to promote maternal role competence , psychological well-being and prevent postpartum depression is essential and of an urgent priority . OBJECTIVE To examine the effects of an interpersonal psychotherapy oriented childbirth education programme on social support , maternal role competence , postpartum depression and psychological well-being in Chinese first-time childbearing women at three-month postpartum . DESIGN , SETTING AND PARTICIPANTS R and omised controlled trial in a regional teaching hospital , Guangzhou 
    Output:
    
Although the competence and quality of non-specialist health workers delivered interventions was expected to be achieved through structured training and ongoing supervision , empirical evaluations of these were scarce .