***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 : The need to provide high quality prenatal care services , which take account of women ’s views and specifically address their need for information , support and communication , has been advocated and group prenatal care , had been suggested as one of the ways to achieve this objective . The purpose of this study was to examine the impact of group versus individual prenatal care on satisfaction and prenatal care use . Methods : This was a cluster-r and omized controlled trial with the health center as the r and omization unit that conducted in 2007 . Satisfaction was measured through a st and ardized question naire , and the Kotelchuck Adequacy of Prenatal Care Utilization Index was used to measure prenatal care utilization . Results : We recruited 678 women ( group prenatal care , ( N= 344 ) and individual prenatal care , ( N=334 ) in the study . Women in group prenatal care model were more satisfied than women in individual prenatal care model in all areas evaluated , including information , communication , co-ordination and quality of care . Group care women were significantly more likely to have adequate prenatal care than individual care women were ( OR=1.35 95 % CI=1.26–1.44 ) . Conclusions : Group prenatal care was associated with a significant improvement in client satisfaction and prenatal care utilization . This model of care has implication s for the planning and provision of prenatal services within public health system , which is moving toward a better quality health care , and increasing use of services OBJECTIVES To estimate the impact of the Integrated Management of Childhood Illness ( IMCI ) strategy on  early-childhood mortality  , we evaluated a  malaria-control project in Benin that implemented IMCI and promoted insecticide-treated nets ( ITNs ) . METHODS We conducted a before- and -after intervention study that included a nonr and omized comparison group . We used the preceding birth technique to measure early-childhood mortality ( risk of dying before age 30 months ) , and we used health facility surveys and household surveys to measure process indicators . RESULTS Most process indicators improved in the area covered by the intervention . Notably , because ITNs were also promoted in the comparison area children 's ITN use increased by about 20 percentage points in both areas . Regarding early-childhood mortality , the trend from baseline ( 1999 - 2001 ) to follow-up ( 2002 - 2004 ) for the intervention area ( 13.0 % decrease ; P < .001 ) was 14.1 % ( P < .001 ) lower than was the trend for the comparison area ( 1.3 % increase ; P = .46 ) . CONCLUSIONS Mortality decreased in the intervention area after IMCI and ITN promotion .  ITN use increased similarly in both study areas , so the mortality impact of ITNs in the 2 areas might have canceled each other out . Thus , the mortality reduction could have been primarily attributable to IMCI 's effect on health care quality and care-seeking BACKGROUND Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed . We assessed the effect of performance-based payment of health-care providers ( payment for performance ; P4P ) on use and quality of child and maternal care services in health-care facilities in Rw and a. METHODS 166 facilities were r and omly assigned at the district level either to begin P4P funding between June , 2006 , and October , 2006 ( intervention group ; n=80 ) , or to continue with the traditional input-based funding until 23 months after study baseline ( control group ; n=86 ) . R and omisation was done by coin toss . We surveyed facilities and 2158 households at baseline and after 23 months . The main outcome measures were prenatal care visits and institutional deliveries , quality of prenatal care , and child preventive care visits and immunisation . We isolated the incentive effect from the re source effect by increasing comparison facilities ' input-based budgets by the average P4P payments made to the treatment facilities . We estimated a multivariate regression specification of the difference-in-difference model in which an individual 's outcome is regressed against a dummy variable , indicating whether the facility received P4P that year , a facility-fixed effect , a year indicator , and a series of individual and household characteristics . FINDINGS Our model estimated that facilities in the intervention group had a 23 % increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger ( 56 % ) and aged between 24 months and 59 months ( 132 % ) . No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules . We also estimate an increase of 0·157 st and ard deviations ( 95 % CI 0·026 - 0·289 ) in prenatal quality as measured by compliance with Rw and an prenatal care clinical practice guidelines . INTERPRETATION The P4P scheme in Rw and a had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider . P4P financial performance incentives can improve both the use and quality of maternal and child health services , and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health . FUNDING World Bank 's Bank-Netherl and s Partnership Program and Spanish Impact Evaluation Fund , the British Economic and Social Research Council , Government of Rw and a , and Global Development Network OBJECTIVE To compare the maternal outcome , in terms of postpartum infection , of deliveries conducted by trained traditional birth attendants ( TBAs ) with those conducted by untrained birth attendants .  METHODS The study took place in a rural area of Bangladesh where a local NGO ( BRAC ) had previously undertaken TBA training . Demographic surveillance in the study site allowed the systematic identification of pregnant women . Pregnant women were recruited continuously over a period of 18 months . Data on the delivery circumstances were collected shortly after delivery while data on postpartum morbidity were collected prospect ively at 2 and 6 weeks . All women with complete records who had delivered at home with a non-formal birth attendant ( 800 ) were included in the analysis . The intervention investigated was TBA training in hygienic delivery comprising the ' three cleans ' ( h and -washing with soap , clean cord care , clean surface ) . The key outcome measure was maternal postpartum genital tract infection diagnosed by a symptom complex of any two out of three symptoms : foul discharge , fever , lower abdominal pain . RESULTS Trained TBAs were significantly more likely to practice hygienic delivery than untrained TBAs ( 45.0 vs. 19.3 % , p < 0.0001 ) . However , no significant difference in levels of postpartum infection was found when deliveries by trained TBAs and untrained TBAs were compared . The practice of hygienic delivery itself also had no significant effect on postpartum infection . Logistic regression models confirmed that TBA training and hygienic delivery had no independent effect on postpartum outcome . Other factors , such as pre-existing infection , long labour and insertion of h and s into the vagina were found to be highly significant . CONCLUSIONS Trained TBAs are more likely to practice hygienic delivery than those that are untrained . However , hygienic delivery practice s do not prevent postpartum infection in this community . Training TBAs to wash their h and s is not an effective strategy to prevent maternal postpartum infection . More rigorous evaluation is needed , not only of TBA training programmes as a whole , but also of the effectiveness of the individual components of the training OBJECTIVE To determine the effects of  hospital quality assurance interventions  on compliance with clinical st and ards , availability of essential drugs , client satisfaction , and utilization . DESIGN Quasi-experimental , prospect i ve study with four intervention hospitals and four control hospitals . All eight facilities were purposively selected and of comparable complexity . SETTING Ministry of Health secondary care facilities in Ecuador . INTERVENTIONS Facility-based quality improvement teams , job clarification , st and ards communication , refresher training , strengthening hospital pharmacy committees , monthly monitoring of compliance indicators , and formation of users ' committees . MEASURES Compliance with input and process st and ards , utilization of services , and patient satisfaction were measured monthly in both groups through review of clinical and administrative records , exit interviews , and patient satisfaction surveys . RESULTS After 12 months , the quality assurance interventions produced rapid increases in compliance with clinical st and ards in the intervention hospitals as compared with the control group . These improvements appeared as early as 2 months after the onset of the interventions . No differences were found between intervention and control groups in terms of trends in utilization patterns or client satisfaction . CONCLUSION Quality assurance interventions made a difference in technical quality of care . Patient satisfaction and utilization do not appear to be directly associated with short-term improvements in compliance with clinical st and ards . Quality improvement interventions may require longer periods and a specific aim at clients ' needs to demonstrate effects on utilization and satisfaction outcome variables Prenatal and delivery care are critical both for maternal and newborn health . Using the Demographic and Health Surveys ( DHS ) data for thirty-two low-income countries across Asia , sub-Saharan Africa and Latin America , and employing a two-level r and om-intercept model , this paper empirically assesses the influence of prenatal attendance and a wide array of observed individual- , household- and community-level characteristics on a woman 's decision to give birth at a health facility or at home . The results show that  prenatal attendance does appreciably influence the use of facility delivery in all three geographical regions , with women having four visits being 7.3 times more likely than those with no prenatal care to deliver at a health facility . These variations are more pronounced for Sub-Saharan Africa . The influence of the number of prenatal visits , maternal age and education , parity level , and economic status of the  birthing women on the place of delivery is found to vary across the three geographical regions . The results also indicate that obstetrics care is geographically and economically more accessible to urban and rural women from the non-poor households than those from the poor households . The strong influence of number of visits , household wealth , education and regional poverty on the site of delivery setting suggests that policies aim ed at increasing the use of obstetric care programs should be linked with the objectives of social development programs such as poverty reduction , enhancing the status of women , and increasing primary and secondary school enrollment rate among girls BACKGROUND We report the preliminary findings from a continuing cluster r and omised evaluation of the Integrated Management of Childhood Illness ( IMCI ) strategy in Bangladesh . METHODS 20 first-level outpatient facilities in the Matlab sub-district and their catchment areas were r and omised to either IMCI or st and ard care . Surveys were done in households and in health facilities at baseline and were repeated about 2 years after implementation . Data on use of health facilities were recorded . IMCI implementation included health worker training , health systems support , and community level activities guided by formative research . FINDINGS 94 % of health workers in the intervention facilities were trained in IMCI . Health systems supports were generally available , but implementation of the community activities was slow . The mean index of correct treatment for sick children was 54 in IMCI facilities compared with 9 in comparison facilities ( range 0 - 100 ) . Use of the IMCI facilities increased from 0.6 visits per child per year at baseline to 1.9 visits per child per year about 21 months after IMCI introduction . 19 % of sick children in the IMCI area were taken to a health worker compared with 9 % in the non-IMCI area . INTERPRETATION 2 years into the assessment , the results show improvements in the quality of care in health facilities , increases in use of facilities , and gains in the proportion of sick children taken to an appropriate health care provider . These findings are being used to strengthen child health care nationwide . They suggest that low levels of use of health facilities could be improved by investing in quality of care and health systems support BACKGROUND WHO and UNICEF launched the Integrated Management of Childhood Illness ( IMCI ) strategy in the mid-1990s to reduce deaths from diarrhoea , pneumonia , malaria , measles , and malnutrition in children younger than 5 years . We assessed the effect of IMCI on health and nutrition of children younger than 5 years in Bangladesh . METHODS In this cluster r and omised trial , 20 first-level government health facilities in the Matlab subdistrict of Bangladesh and their catchment areas ( total population about 350 000 ) were paired and r and omly assigned to either IMCI ( intervention ; ten clusters ) or usual services ( comparison ; ten clusters ) . All three components of IMCI-health-worker training , health-systems improvements , and family and community activities-were implemented beginning in February , 2002 . Assessment included household and health facility surveys tracking intermediate outputs and outcomes , and nutrition and mortality changes in intervention and comparison areas . Primary endpoint was mortality in children aged between 7 days and 59 months .  Analysis was by intention to treat . This study is registered , number IS RCT N52793850 . FINDINGS The yearly rate of mortality reduction in children younger than 5 years ( excluding deaths in first week of life ) was similar in IMCI and comparison areas ( 8.6%vs 7.8 % ) . In the last 2 years of the study , the mortality rate was 13.4 % lower in IMCI than in comparison areas ( 95 % CI -14.2 to 34.3 ) , corresponding to 4.2 fewer deaths per 1000 livebirths ( 95 % CI -4.1 to 12.4 ; p=0.30 ) . Implementation of IMCI led to improved health-worker skills , health-system support , and family and community practice s , translating into increased care-seeking for illnesses . In IMCI areas , more children younger than 6 months were exclusively breastfed ( 76%vs 65 % , difference of differences 10.1 % ,  
    Output:
    
Studies relied heavily on service utilisation as a measure of strategy success , which did not always correspond to improved quality .