***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 Abstract s Background Skilled care during and immediately after delivery has been identified as one of the key strategies in reducing maternal mortality . However , recent estimates show that the status of skilled care during delivery remained very low in Ethiopia . Birth preparedness and complication readiness has been implemented as comprehensive strategy to fill this gap . However , its effectiveness in improving skilled care use has n’t been well studied . Objective The objective of this study was to determine the effect of birth preparedness and complication readiness on skilled care use in Southwest Ethiopia . Methods A prospect i ve follow-up study was conducted from September 2012-April 2013 in Southwest Ethiopia among r and omly selected 3472 mothers . Data were collected by using pre-tested interviewer administered question naires and analyzed by using SPSS for windows V.20.0 and STATA 13 . Mixed-effects multilevel logistic regression model was used to look at the relation between birth preparedness and complication readiness plan and skilled care use and identify other determinant factors . Results The status of skilled care use was 17.5 % ( 95 % CI : 16.2 % , 18.8 % ) . Factors affecting skilled care use existed both at the community as well as individual levels . Planning to use skilled care during pregnancy was found to increase actual use significantly ( OR = 2.24 ; 95%CI : 1.60 , 3.15 ) . Place of residence , access to basic emergency obstetric care , maternal education , husb and ’s occupation , wealth quintiles , number of pregnancy , inter-birth interval , knowledge of key danger signs during labor and ANC use were identified as factors affecting skilled care use . Conclusions The status of skilled care use was found to be low in the study area .  Birth preparedness and complication readiness had significant effect on skilled care use . Socio-demographic , economic , access to health facility , maternal obstetric factors and antenatal care were identified as determinant factors for skilled care use . Design ing appropriate interventions to improve information , education and communication , antenatal care use , family planning and knowledge of key danger signs are recommended OBJECTIVES To determine the effectiveness of birth plans in increasing use of skilled care at delivery and in the postnatal period among antenatal care ( ANC ) attendees in a rural district with low occupancy of health units for delivery but high antenatal care uptake in northern Tanzania . METHODS Cluster r and omised trial in Ngorongoro district , Arusha region , involving 16 health units ( 8 per arm ) . Nine hundred and five pregnant women at 24 weeks of gestation and above ( 404 in the intervention arm ) were recruited and followed up to at least 1 month postpartum . RESULTS Skilled delivery care uptake was 16.8 % higher in the intervention units than in the control [ 95 % CI 2.6 - 31.0 ; P = 0.02 ] . Postnatal care utilisation in the first month of delivery was higher ( difference in proportions : 30.0 % [ 95 % CI 1.3 - 47.7 ; P < 0.01 ] ) and also initiated earlier ( mean duration 6.6 ± 1.7 days vs. 20.9 ± 4.4 days , P < 0.01 ) in the intervention than in the control arm . Women 's and providers ' reports of care satisfaction ( received or provided ) did not differ greatly between the two arms of the study ( difference in proportion : 12.1 % [ 95 % CI -6.3 - 30.5 ] P = 0.17 and 6.9 % [ 95 % CI -3.2 - 17.1 ] P = 0.15 , respectively ) . CONCLUSION Implementation of birth plans during ANC can increase the uptake of skilled delivery and post delivery care in the study district without negatively affecting women 's and providers ' satisfaction with available ANC services . Birth plans should be considered along with the range of other recommended interventions as a strategy to improve the uptake of maternal health services Background To evaluate a delivery strategy for newborn interventions in rural Bangladesh . Methods A cluster-r and omized controlled trial was conducted in Mirzapur , Bangladesh . Twelve unions were r and omized to intervention or comparison arm . All women of reproductive age were eligible to participate . In the intervention arm , community health workers identified pregnant women ; made two antenatal home visits to promote birth and newborn care preparedness ; made four postnatal home visits to negotiate preventive care practice s and to assess newborns for illness ; and referred sick neonates to a hospital and facilitated compliance . Primary outcome measures were antenatal and immediate newborn care behaviours , knowledge of danger signs , care seeking for neonatal complications , and neonatal mortality . Findings A total of 4616 and 5241 live births were recorded from 9987 and 11153 participants in the intervention and comparison arm , respectively . High coverage of antenatal ( 91 % visited twice ) and postnatal ( 69 % visited on days 0 or 1 ) home visitations was achieved . Indicators of care practice s and knowledge of maternal and neonatal danger signs improved . Adjusted mortality hazard ratio in the intervention arm , compared to the comparison arm , was 1.02 ( 95 % CI : 0.80–1.30 ) at baseline and 0.87 ( 95 % CI : 0.68–1.12 ) at endline . Primary causes of death were birth asphyxia ( 49 % ) and prematurity ( 26 % ) . No adverse events associated with interventions were reported . Conclusion Lack of evidence for mortality impact despite high program coverage and quality assurance of implementation , and improvements in targeted newborn care practice s suggests the intervention did not adequately address risk factors for mortality . The level and cause-structure of neonatal mortality in the local population must be considered in developing interventions . Programs must ensure skilled care during childbirth , including management of birth asphyxia and prematurity , and curative postnatal care during the first two days of life , in addition to essential newborn care and infection prevention and management . Trial Registration Clinical trials.gov Background Fetal and neonatal mortality rates in low-income countries are at least 10-fold greater than in high-income countries . These differences have been related to poor access to and poor quality of obstetric and neonatal care . Methods This trial tested the hypothesis that teams of health care providers , administrators and local residents can address the problem of limited access to quality obstetric and neonatal care and lead to a reduction in perinatal mortality in intervention compared to control locations . In seven geographic areas in five low-income and one middle-income country , most with high perinatal mortality rates and substantial numbers of home deliveries , we performed a cluster r and omized non-masked trial of a package of interventions that included community mobilization focusing on birth planning and hospital transport , community birth attendant training in problem recognition , and facility staff training in the management of obstetric and neonatal emergencies . The primary outcome was perinatal mortality at ≥28 weeks gestation or birth weight ≥1000 g. Results Despite extensive effort in all sites in each of the three intervention areas , no differences emerged in the primary or any secondary outcome between the intervention and control clusters . In both groups , the mean perinatal mortality was 40.1/1,000 births ( P = 0.9996 ) . Neither were there differences between the two groups in outcomes in the last six months of the project , in the year following intervention cessation , nor in the clusters that best implemented the intervention . Conclusions This cluster r and omized comprehensive , large-scale , multi-sector intervention did not result in detectable impact on the proposed outcomes . While this does not negate the importance of these interventions , we expect that achieving improvement in pregnancy outcomes in these setting s will require substantially more obstetric and neonatal care infrastructure than was available at the sites during this trial , and without them provider training and community mobilization will not be sufficient . Our results highlight the critical importance of evaluating outcomes in r and omized trials , as interventions that should be effective may not be . Trial registration Clinical Trials.gov Background Antenatal care provides an important opportunity to improve maternal underst and ing of care during and after pregnancy . Yet , studies suggest that communication is often insufficient . This research examined the effect of a job aids-focused intervention on quality of counseling and maternal underst and ing of care for mothers and newborns . Methods Counseling job aids were developed to support provider communication to pregnant women . Fourteen health facilities were r and omized to control or intervention , where providers were trained to use job aids and provided implementation support . Direct observation of antenatal counseling sessions and patient exit interviews were undertaken to assess quality of counseling and maternal knowledge . Providers were also interviewed regarding their perceptions of the tools . Data were collected before and after the job aids intervention and analyzed using a difference-in-differences analysis to quantify relative changes over time . Results Mean percent of recommended messages provided to  pregnant women significantly improved in the intervention arm as compared to the control arm in birth preparedness ( difference-in-differences [ ΔI-C ] = + 17.9 , 95%CI : 6.7,29.1 ) , danger sign recognition ( ΔI-C = + 26.0 , 95%CI : 14.6,37.4 ) , clean delivery ( ΔI-C = + 21.7 , 95%CI : 10.9,32.6 ) , and newborn care ( ΔI-C = + 26.2 , 95%CI : 13.5,38.9 ) . Significant gains were also observed in the mean percent of communication techniques applied ( ΔI-C = + 28.8 , 95%CI : 22.5,35.2 ) and duration ( minutes ) of antenatal consultations ( ΔI-C = + 5.9 , 95%CI : 3.0,8.8 ) . No relative increase was found for messages relating to general prenatal care ( ΔI-C = + 8.2 , 95%CI : -2.6,19.1 ) . The proportion of pregnant women with correct knowledge also significantly improved for birth preparedness ( ΔI-C = + 23.6 , 95%CI : 9.8,37.4 ) , danger sign recognition ( ΔI-C = + 28.7 , 95%CI : 14.2,43.2 ) , and clean delivery ( ΔI-C = + 31.1 , 95%CI : 19.4,42.9 ) . There were no significant changes in maternal knowledge of general prenatal ( ΔI-C = -6.4 , 95%CI : -21.3,8.5 ) or newborn care ( ΔI-C = + 12.7 , 95%CI : -6.1,31.5 ) . Job aids were positively perceived by providers and pregnant women , although time constraints remained for health workers with other clinical responsibilities . Conclusions This study demonstrates that a job aids-focused intervention can be integrated into routine antenatal care with positive outcomes on provider communication and maternal knowledge . Efforts are needed to address time constraints and other communication barriers , including introduction of on-going quality assessment for long-term sustainability BACKGROUND In rural India , most births take place in the home , where high-risk care practice s are common . We developed an intervention of behaviour change management , with a focus on prevention of hypothermia , aim ed at modifying practice s and reducing neonatal mortality . METHODS We did a cluster-r and omised controlled efficacy trial in Shivgarh , a rural area in Uttar Pradesh . 39 village administrative units ( population 104,123 ) were allocated to one of three groups : a control group , which received the usual services of governmental and non-governmental organisations in the area ; an intervention group , which received a preventive package of interventions for essential newborn care ( birth preparedness , clean delivery and cord care , thermal care [ including skin-to-skin care ] , breastfeeding promotion , and danger sign recognition ) ; or another intervention group , which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator ( ThermoSpot ) . In the intervention clusters , community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations . Outcome measures included changes in newborn-care practice s and neonatal mortality rate 
    Output:
    
Although most studies focus on women as the main target group , multi-stakeholder participation with interventions occurring simultaneously at both community and facility level facilitated the impact on seeking skilled care at birth .
Increase in formal education for women most likely contributed positively to results .