***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 conduct the first rigorous evaluation of the long-term effect of the Comprehensive Rural Health Project on  childhood mortality in rural Maharashtra . METHODS Background information and full birth histories were collected by conducting household surveys and interviewing  women . Control villages resembling project villages in terms of population size were r and omly selected from an area enclosed by two ellipses centred around , but not including , the project area . An equal number of villages and approximately equal numbers of households and women were r and omly sample d from both areas . Cox models with robust st and ard errors were used to compare the hazard of death among children under 5 years of age in project and control villages . FINDINGS The hazard of death was reduced by 30 % ( 95 % confidence interval , CI : 6 % to 48 % ) after the neonatal period in the project villages compared with control villages after adjustment for caste and religion of subjects and for availability of irrigation in the villages . During the neonatal period there was an increase of 3 % in the hazard of death , but it was not statistically significant ( 95 % CI : -18 % to 29 % ) . CONCLUSION Our methods provide useful tools for evaluating long-running community-based primary health care programmes . Our findings add to the growing debate on the long-term sustainability of community-based interventions design ed to reduce child mortality The adage “ do n’t throw the baby out with the bathwater ” advises us not to discard the essential along with the unessential , whether due to impatience or frustration . 1 This issue of the journal includes reports on prospect i ve evaluations of the integrated community case management ( iCCM ) of childhood illness strategy in Burkina Faso , 2 Ethiopia , 3 and Malawi . 4 iCCM seeks to reduce child mortality by making effective treatment of pneumonia , diarrhea , and malaria available from trained health workers at community level . 5 In this commentary , we show results from the three countries , highlighting hard-won lessons about iCCM ’s potential to prevent unnecessary deaths among children . The independent iCCM evaluations were design ed in 2009– 2010 , as a part of the Catalytic Initiative to Save a Million Lives 6 spearheaded by Canada and involving the Bill & Melinda Gates Foundation , the U.K. Department for International Development , the United Nations Children ’s Fund , the World Health Organization , the Doris Duke Charitable Foundation , and others . The goal of the Catalytic Initiative was to support and measure the impact of strong , coordinated efforts to deliver high-impact interventions to reduce  under-five mortality  in low-income , high-burden countries , with a particular focus on providing treatment for childhood pneumonia , diarrhea , and malaria at community level using iCCM . The evaluation in each setting was conducted in collaboration with local research institutions , based on a locally adapted version of the common evaluation framework for maternal , newborn , and child health ( MNCH ) . 7 The evaluation design s were built on impact models reflecting the pathway to child survival . Beginning with policy and program inputs , the pathway moves to project implementation and intermediate outputs such as improved provision of quality services , strengthened health systems , and increased utilization . Continuing to coverage and behavioral outcomes , the pathway culminates in impact of under-five and postneonatal mortality . We focus on  mortality among children aged 2–59 months here , because the iCCM strategy did not include guidelines for children under 2 months of age . Detailed methods are described in the individual papers ; Table 1 provides a summary . All sites documented program inputs and context ual factors that may have affected program implementation or effectiveness . The evaluation teams shared intermediate and final results with governments and partners as a basis for strengthening iCCM implementation . Selected results across the three countries are shown in Table 2 . We reanalyzed some variables to maximize comparability across countries ; in some instances , results presented here are not included in the series papers . iCCM was not associated with accelerated mortality declines  in children aged 2–59 months during the 2- to 4-year evaluation periods in these three setting s. The reasons for this lack of association likely varied across setting s , as does the likelihood that these programs may achieve measureable impact after additional years of sustained implementation . In Burkina Faso , iCCM implementation did not reflect current best practice for design ing and implementing effective MNCH programs . The program relied on community health worker ( CHW ) lay volunteers . The initial training was organized as a “ cascade ” in which representatives from districts were trained and then requested to organize subdistrict-level training sessions to train over 3,000 CHWs in the space of a few months , with minimal support or supervision . The training included written material s even though many of the Objective To determine the effect of implementation of the Integrated Management of Neonatal and Childhood Illness strategy on treatment seeking practice s and on  neonatal and infant morbidity .  Design Cluster r and omised trial . Setting Haryana , India . Participants 29 667 births in nine intervention clusters and 30 813 births in nine control clusters . Main outcome measures The pre-specified outcome was the effect on treatment seeking practice s. Post hoc exploratory analyses assessed morbidity , hospital admission , post-neonatal infant care , and nutritional status outcomes . Interventions The Integrated Management of Neonatal and Childhood Illness intervention included home visits by community health workers , improved case management of sick children , and strengthening of health systems . Outcomes were ascertained through interviews with r and omly selected caregivers : 6204 , 3073 , and 2045 in intervention clusters and 6163 , 3048 , and 2017 in control clusters at ages 29 days , 6 months , and 12 months , respectively . Results In the intervention cluster , treatment was sought more often from an appropriate provider for severe neonatal illness ( risk ratio 1.76 , 95 % confidence interval 1.38 to 2.24 ) , for local neonatal infection ( 4.86 , 3.80 to 6.21 ) , and for diarrhoea at 6 months ( 1.96 , 1.38 to 2.79 ) and 12 months ( 1.22 , 1.06 to 1.42 ) and pneumonia at 6 months ( 2.09 , 1.31 to 3.33 ) and 12 months ( 1.44 , 1.00 to 2.08 ) . Intervention mothers reported fewer episodes of severe neonatal illness ( risk ratio 0.82 , 0.67 to 0.99 ) and lower prevalence of diarrhoea ( 0.71 , 0.60 to 0.83 ) and pneumonia ( 0.73 , 0.52 to 1.04 ) in the two weeks preceding the 6 month interview and of diarrhoea ( 0.63 , 0.49 to 0.80 ) and pneumonia ( 0.60 , 0.46 to 0.78 ) in the two weeks preceding the 12 month interview . Infants in the intervention clusters were more likely to still be exclusively breast fed in the sixth month of life ( risk ratio 3.19 , 2.67 to 3.81 ) . Conclusion Implementation of the Integrated Management of Neonatal and Childhood Illness programme was associated with timely treatment seeking from appropriate providers and reduced morbidity , a likely explanation for the reduction in mortality observed following implementation of the programme in this study . Trial registration Clinical trials NCT00474981 ; ICMR Clinical Trial Registry CTRI/2009/091/000715 OBJECTIVE To conduct an impact assessment of an intervention to enhance the provision of community-based integrated services for tuberculosis ( TB ) , human immunodeficiency virus ( HIV ) and prevention of mother-to-child transmission ( PMTCT ) . METHODS The intervention consisted of a combination of training of community care workers ( CCWs ) , structural adjustments , harmonisation of scope of practice and stipend of CCWs and enhanced supervision of CCWs to provide comprehensive TB-HIV/PMTCT services  in a rural South African district . A before and after study design was used with a household survey to assess the operational effectiveness of the intervention . Six clusters were r and omised into intervention and control arms . Quantitative data were analysed using logistic regression , adjusting for cluster design . RESULTS Logistic regression analyses of the survey data show that CCWs from the intervention arm performed better in the provision of TB-HIV/PMTCT services , such as screening for TB and sexually transmitted infections , adherence to anti-tuberculosis treatment and antiretroviral therapy and counselling on infant feeding compared to the control CCWs ( P < 0.05 ) . However , intervention CCWs performed worse in the integrated management of childhood illnesses education and social welfare referrals ( P < 0.05 ) . The uptake of HIV testing increased significantly in the intervention arm , from 55 % to 78 % ( P < 0.001 ) . CONCLUSION The intervention was effective in enhancing the provision of community-based TB-HIV and PMTCT services . However , attention to other primary health care services is required to ensure that all key services are provided BACKGROUND Evidence suggests that community-based interventions that promote improved home-based practice s and care-seeking behaviour can have a large impact on maternal and child mortality in regions where rates are high . We aim ed to assess whether an intervention package based on the WHO Integrated Management of Childhood Illness h and book and community mobilisation could reduce  under-5 mortality in rural Guinea-Bissau , where the health service infrastructure is weak . METHODS We did a non-masked cluster-r and omised controlled trial ( EPICS ) in the districts of Tombali and Quinara in Guinea-Bissau . Clusters of rural villages were stratified by ethnicity and distance from a regional health centre , and r and omly assigned ( 1:1 ) to intervention or control using a computerised r and om number generator . Women were eligible if they lived in one of the clusters at baseline survey prior to r and omisation and if they were aged 15 - 49 years or were primary caregivers of children younger than 5 years . Their children were eligible if they were younger than 5 years or were liveborn after intervention services could be implemented on July 1 , 2008 . In villages receiving the intervention , community health clubs were established , community health workers were trained in case management , and traditional birth attendants were trained to care for pregnant women and newborn babies , and promote facility-based delivery . Registered nurses supervised community health workers and offered mobile clinic services . Health centres were not improved . The control group received usual services . The primary outcome was the proportion of children dying under age 5 years , and was analysed in all eligible children up to final visits to villages between Jan 1 and March 31 , 2011 . This trial is registered with IS RCT N , number IS RCT N52433336 . FINDINGS On Aug 30 , 2007 , we r and omly assigned 146 clusters to intervention ( 73 clusters , 5669 women , and 4573 children ) or control ( 73 clusters , 5840 women , and 4675 children ) . From r and omisation until the end of the trial ( last visit by June 30 , 2011 ) , the intervention clusters had 3093 livebirths and the control clusters had 3194 . 6729 children in the intervention group and 6894 in the control group aged 0 - 5 years on July 1 , 2008 , or liveborn subsequently were analysed for mortality outcomes . 311 ( 4·6 % ) of 6729 children younger than 5 years died in the intervention group compared with 273 ( 4·0 % ) of 6894 in the control group ( relative risk 1·16 [ 95 % CI 0·99 - 1·37 ] ) . INTERPRETATION Our package of community-based interventions did not reduce under-5 mortality in rural Guinea-Bissau . The short timeframe and other trial limitations might have affected our results . Community-based health promotion and basic first-line services in fragile context s with weak secondary health service infrastructure might be insufficient to reduce child deaths . FUNDING Effective Intervention Objective To evaluate the Indian Integrated Management of Neonatal and Childhood Illness ( IMNCI ) programme , which integrates improved treatment of illness for children with home visits for newborn care  , to inform its scale-up . Design Cluster r and omised trial . Setting 18 clusters ( population 1.1 million ) in Haryana , India . Participants 29 667 births in intervention clusters and 30 813 in control clusters . Intervention Community health workers were trained to conduct postnatal home visits and women ’s group meetings ; physicians , nurses , and community health workers were trained to treat or refer sick newborns and children ; supply of drugs and supervision were strengthened . Main outcome measures Neonatal and infant mortality ; newborn care practice s. Results The infant mortality rate ( adjusted hazard ratio 0.85 , 95 % confidence interval 0.77 to 0.94 ) and the neonatal mortality rate beyond the first 24 hours ( adjusted hazard ratio 0.86 , 0.79 to 0.95 ) were significantly lower in the intervention clusters than in control clusters . The adjusted hazard ratio for neonatal mortality rate was 0.91 ( 0.80 to 1.03 ) . A significant interaction was found between the place of birth and the effect of the intervention for all mortality outcomes except post-neonatal mortality rate . The neonatal mortality rate was significantly lower in the intervention clusters in the subgroup born at home ( adjusted hazard ratio 0.80 , 0.68 to 0.93 ) but not in the subgroup born in a health facility ( 1.06 , 0. 
    Output:
    
Conclusion Proactive case detection may provide promising benefits for child health , but evidence is insufficient to draw conclusions .