***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: OBJECTIVE To determine the impact of Maternal and Child Health ( MCH ) services on  child survival in a socio-economically backward rural community . SETTING Twelve villages in Pondicherry with a population of 16,803 . DESIGN Prospect i ve study . SUBJECTS A birth cohort of 356 live births ( LB ) born between January 1st and December 31st 1988 . METHODS The live births were followed-up from birth to five years age ( 1988 - 1993 ) . The health care received by this cohort and the antenatal services received by the cohort mothers was review ed . Outcome measures related to child survival were determined and their changing trend since 1967 was examined . RESULTS Fifty-four per cent of the cohort children were from families below the poverty line . Antenatal registration and tetanus immunization coverage of the mothers of the cohort was 100 % . Immunization coverage of the cohort children was more than 98 % for BCG , DPT ( three doses ) and OPV ( three doses ) and 82 % for measles . The infant mortality rate had reduced from 201/1000 LB in 1967 to 64/1000 LB ( 95 % CI 58.9 - 68.1 ) in 1989 . The child death rate decreased from 29.4/1000 children 1 - 4 years of age ( 1970 ) to 18/1000 ( 95 % CI 13.9 - 22.1 ) in 1992 . There were no deaths due to neonatal tetanus or measles . Neonatal mortality ( 35/1000 LB ; 95 % CI 29.9 - 40.1 ) was higher than the post-neonatal mortality ( 29/1000 LB ; 95 % CI 24.1 - 33.9 ) . Fifty eight per cent of the neonatal deaths were due to non-infective causes like prematurity , birth asphyxia , birth injuries and congenital anomalies . Eighty per cent of post neonatal deaths were due to infections . Overall , the child survival index was high ( 91.27 % ; 95 % CI 88.14 - 94.26 ) . This was inspite of the low socio-economic background of the children 's families . CONCLUSIONS Good MCH services can substantially improve child survival inspite of prevailing low socio-economic situations . Inputs for neonatal care need to be strengthened to further enhance child survival To achieve the goal of validity , the r and omized clinical  trial has emerged as the scientific " gold st and ard " for evaluating therapies in clinical medicine . Regardless of how well r and omized clinical trials are design ed , however , problems often occur during the conduct of the trials that give rise to method ologic challenges in the analysis of results . Primarily two types of problems , changes in intended treatment and the failure to ascertain the study outcomes , occur during the conduct of r and omized clinical trials . We studied the current analytic strategies that are used to deal with these problems and how the use of these analytic strategies can change the focus of the research so that the trial no longer answers the relevant question . To ensure that the right question is answered , new methods of design and analysis are required that balance the goals of validity and clinical pertinence The effects on  pregnancy outcome  and  maternal iron status of powdered milk ( PUR ) and a milk-based fortified product ( V-N ) were compared in a group of underweight gravidas . These take-home products were distributed during regular prenatal visits . Women in the V-N group had greater weight gain ( 12.29 vs 11.31 kg , p less than 0.05 ) and mean birth weights ( 3178 vs 3105 g , p less than 0.05 ) than those in the PUR group . Values for various indicators of maternal Fe status were also higher in the V-N group . Compared with self-selected noncompliers , similar in all control variables to compliers , children of women who consumed powdered milk or the milk-based fortified product had mean birth weights that were higher by 258 and 335 g , respectively . Data indicate a beneficial effect of the fortified product on both maternal nutritional status and fetal growth To estimate the effect of maternal zinc deficiency on pregnancy outcomes , we conducted a zinc supplementation trial in an urban shantytown in Lima , Peru , a population with habitual low zinc intakes . Beginning at 10 - 24 wk gestation , 1295 mothers were r and omly assigned to receive prenatal supplements containing 60 mg iron and 250 ( g folate , with or without 15 mg zinc . Women were followed up monthly during pregnancy . At birth , newborn weight was recorded , and crownheel length , head circumference and other circumferences and skinfold thicknesses were assessed on d 1 . At delivery , 1016 remained in the study ;  duration of pregnancy  was known for all women , and birth weight information was available for 957 newborns . No differences were noted in duration of pregnancy ( 39.4 + /- 2.2 vs. 39 . 5 + /- 2.0 wk ) or birth weight ( 3267 + /- 461 vs. 3300 + /- 498 g ) by prenatal supplement type ( iron + folate + zinc vs. iron + folate ; P > 0.05 ) , and there were no differences in the rates of preterm ( < 37 wk ) or post-term ( > 42 wk ) delivery , low birth weight ( < 2500 g ) or high birth weight ( > 4000 g ) . Finally , there were no differences by prenatal supplement type in newborn head circumference , crownheel length , chest circumference , mid-upper arm circumference , calf circumference or skinfold thickness at any of three sites . Adjustment for covariates and confounding factors did not alter these results . Adding zinc to prenatal iron and folate tablets did not affect duration of pregnancy or size at birth in this population BACKGROUND Little is known about the benefits of prenatal multivitamin and mineral supplements in reducing  low birth weight .  OBJECTIVE We conducted a r and omized , double-blind clinical trial in semirural Mexico to compare the effects of multiple micronutrient ( MM ) supplements with those of iron supplements during pregnancy on birth size . DESIGN Pregnant women ( n = 873 ) were recruited before 13 wk of gestation and received supplements 6 d/wk at home , as well as routine antenatal care , until delivery . Both supplements contained 60 mg Fe , but the MM group also received 1 - 1.5 times the recommended dietary allowances of several micronutrients . RESULTS At recruitment , the women in the 2 groups were not significantly different in age , parity , economic status , height , or hemoglobin concentration but differed significantly in marital status ( 4.6 % and 2.0 % of women in the MM and iron-only groups , respectively , were single mothers ) and mean ( + /- SD ) body mass index ( in kg/m(2 ) ; 24.6 + /- 4.3 and 23.8 + /- 3.9 in the iron-only and MM groups , respectively ) . Losses to follow-up ( 25 % ) and compliance ( 95 % ) did not differ significantly between the groups . In intent-to-treat analyses ( MM group : n = 323 ; iron-only group : n = 322 ) , mean ( + /- SD ) birth weight ( 2.981 + /- 0.391 and 2.977 + /- 0.393 kg in the MM and iron-only groups , respectively ) and birth length ( 48.61 + /- 1.82 and 48.66 + /- 1.83 cm in the MM and iron-only groups , respectively ) did not differ significantly between the groups . CONCLUSION These findings suggest that MM supplementation during pregnancy does not lead to greater infant birth size than does iron-only supplementation 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 OBJECTIVES In their efforts to reduce maternal and neonatal morbidity and mortality , many national and international agencies make considerable investments in training traditional birth attendants ( TBAs ) . The value of TBA training is controversial , and plausible arguments are made both for and against . Numerous process evaluations are reported in the literature and the results are mixed , though generally positive . Outcome evaluations , however , are scarce . This article describes an outcome evaluation of  TBA training conducted in two districts of Brong-Ahafo Region , Ghana , during 1996 . DESIGN AND METHODS Data from a r and om sample survey of 1961 clients of TBAs were subjected to logistic regression modelling to determine the effect of training on maternal outcomes , controlling for other independent variables . RESULTS Of eight outcomes modelled , three were associated with training and five were not . Three additional outcomes were not modelled , primarily due to low prevalence . CONCLUSIONS Despite some inherent design limitations , this study found that the evidence for a beneficial impact of TBA training was not compelling . Training sponsors should consider alternative health investments and , where TBA training remains the intervention of choice , be realistic about expectations of impact BACKGROUND No satisfactory strategy for reducing  high child mortality  from malaria has yet been established in tropical Africa . We compared the effect on under-5 mortality of  teaching mothers  to promptly provide antimalarials to their sick children at home , with the present community health worker approach . METHODS Of 37 tabias ( cluster of villages ) in two districts with hyperendemic to holoendemic malaria , tabias reported to have the highest malaria morbidity were selected . A census was done which included a maternity history to determine under-5 mortality .  Tabias ( population 70,506 ) were paired according to under-5 mortality rates . One tabia from each pair was allocated by r and om number to an intervention group and the other was allocated to the control group . In the intervention tabias , mother coordinators were trained to teach other local mothers to recognise symptoms of malaria in their children and to promptly give chloroquine . In both intervention and control tabias , all births and deaths of under-5s were recorded monthly . FINDINGS From January to December 1997 , 190 of 6383 ( 29.8 per 1000 ) children under-5 died in the intervention tabias compared with 366 of 7294 ( 50.2 per 1000 ) in the control tabias . Under-5 mortality was reduced by 40 % in the intervention localities ( 95 % CI from 29.2 - 50.6 ; paired t test , p<0.003 ) . For every third child who died , a structured verbal autopsy was undertaken to ascribe cause of mortality as consistent with malaria or possible malaria , or not consistent with malaria . Of the 190 verbal autopsies , 13 ( 19 % ) of 70 in the intervention tabias were consistent with possible malaria compared with 68 ( 57 % ) of 120 in the control tabias . INTERPRETATION A major reduction in under-5 mortality can be achieved in holoendemic malaria areas through training local mother coordinators to teach mothers to give under-5 children antimalarial drugs BACKG 
    Output:
    
Interventions appeared largely bundled out of convenience or funding requirements , rather than based on anticipated synergistic effects , like service delivery mode or cost-effectiveness .