***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 Most mothers breastfeed in Bangladesh , but they rarely practise exclusive breastfeeding . Hospital-based strategies for breastfeeding promotion can not reach them because about 95 % have home deliveries . We postulated that with the intervention of trained peer counsellors , mothers could be enabled to breastfeed exclusively for the recommended duration of 5 months . METHODS 40 adjacent zones in Dhaka were r and omised to intervention or control groups . Women were enrolled during the last trimester of pregnancy between February and December , 1996 . In the intervention group , 15 home-based counselling visits were scheduled , with two visits in the last trimester , three early postpartum ( within 48 h , on day 5 , between days 10 and 14 ) , and fortnightly thereafter until the infant was 5 months old . Peer counsellors were local mothers who received 10 days ' training . FINDINGS 363 women were enrolled in each group .  Peer counselling significantly improved breastfeeding practice s. For the primary outcome , the prevalence of exclusive breastfeeding at 5 months was 202/228 ( 70 % ) for the intervention group and 17/285 ( 6 % ) for the control group ( difference=64 % ; 95 % CI 57%-71 % , p>0.0001 ) . For the secondary outcomes , mothers in the intervention group initiated breastfeeding earlier than control mothers and were less likely to give prelacteal and postlacteal foods . At day 4 , significantly more mothers in the intervention group breastfed exclusively than controls . INTERPRETATION Peer counsellors can effectively increase the initiation and duration of exclusive breastfeeding . We recommend incorporation of peer counsellors in mother and child health programmes in developing countries Various community-based interventions have been proposed to improve maternity care , but hardly any studies have reported the effect of these measures on maternal mortality . In this study , the efficacy of a maternity-care programme to reduce  maternal mortality has been evaluated in the context of a primary health-care project in rural Bangladesh .  Trained midwives were posted in villages , and asked to attend as many home-deliveries as possible , detect and manage obstetric complications at onset , and accompany patients requiring referral for higher-level care to the project central maternity clinic . The effect of the programme was evaluated by comparison of direct obstetric maternal mortality ratios between the programme area and a neighbouring control area  without midwives . R and om assignment of the intervention was not possible but potentially confounding characteristics , including coverage and use of other health and family planning services , were similar in both areas . Maternal mortality ratios due to obstetric complications were similar in both areas during the 3 years preceding the start of the programme . By contrast , during the following 3 years , the ratio was significantly lower in the programme than in the control area ( 1.4 vs 3.8 per 1000 live births , p = 0.02 ) . The findings suggest that maternal survival can be improved by the posting of midwives at village level , if they are given proper training , means , supervision , and back-up . The inputs for such a programme to succeed and the constraints of its replication on a large scale should not be underestimated 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 STUDY OBJECTIVES : The main aim of the study was to discover if a midwife home visiting programme has a significant effect on the prevalence of health problems and breast feeding behaviour of mothers who delivered normally and their healthy fullterm newborn babies , during a period of 42 days after delivery . Another aim was to compare the mothers ' , the midwife 's , and the doctor 's findings of prevalence of health problems at the end of the puerperium period . DESIGN : A r and omised controlled trial was carried out . One group of mothers and their infants were r and omly allocated to a home visiting group ( Group A ) ; the other group ( Group B ) was only visited at day 42 . SETTING : The study was carried out at the University Teaching Hospital ( UTH ) in Lusaka , the capital city of Zambia . PARTICIPANTS : A total of 408 mothers who had a normal delivery and gave birth to a healthy fullterm infant , as assessed by the attending midwife , were r and omised to two groups . Group A consisted of 208 mother/infant dyads who were visited by a midwife in their homes at days 3 , 7 , 28 , and 42 after delivery and Group B consisted of 200 mother/infant dyads who were only visited at day 42 . MAIN RESULTS : At day 42 an equal proportion ( 30 % ) of mothers in both groups perceived that they had health problems . The prevalence of infant health problems in Group B was significantly higher ( p < 0.01 ) as perceived by mothers . There were more mothers in Group B ( p < 0.01 ) perceiving insufficient milk production and giving supplementary feeding . At day 42 , mothers in Group A ( 56 % ) took more actions than mothers in Group B ( 41 % ) to solve infant health problems ( p < 0.03 ) . In both groups the mothers ' perceived own health problems , were significantly higher ( p < 0.01 ) than those observed by the obstetrician and those observed by the midwife . The midwife found more infant health problems in Group B ( p < 0.01 ) than in Group A and more infants with health problems in both groups compared with the paediatrician 's findings ( p < 0.01 ) . CONCLUSIONS : There was a significant difference between the mothers ' reported health problems and the health problems identified by the midwife and the doctors . The study shows that a midwife home visit and individual health education to mothers , reduce the prevalence of infant health problems , and enables the mother to more often take action when an infant health problem is identified . There is a need to re-evaluate the midwifery training curriculums with the intention to include more infant management care OBJECTIVE : We found a high burden of morbidities in a cohort of neonates observed in rural Gadchiroli , India . We hypothesised that interventions would reduce the incidence of neonatal morbidities , including the seasonal increase observed in many of them . This article reports the effect of home-based neonatal care on neonatal morbidities in the intervention arm of the field trial by comparing the early vs late periods , and the possible explanation for this effect . METHODS : During 3 years ( 1995 to 1998 ) ,  trained village-health-workers ( VHWs ) in 39 villages prospect ively collected data by making home visits during pregnancy , home-delivery and during neonatal period . We estimated the incidence and burden of neonatal morbidities over the 3 years from these data . In the first year , the VHWs made home visits only to observe . From the second year , they assisted mothers in neonatal care and managed the sick neonates at home . Health education of mothers and family members , individually and in group , was added in the third year . We measured the coverage of interventions over the 3 years and evaluated maternal knowledge and practice s on 21 indicators in the third year . The effect on 17 morbidities was estimated by comparing the incidence in the first year with the third year . RESULTS : The VHWs observed 763 neonates in the first year , 685 in the second and 913 in the third year . The change in the percent incidence of morbidities was ( i ) infections , from 61.6 to 27.5 ( −55 % ; p<0.001 ) , ( ii ) care-related morbidities ( asphyxia , hypothermia , feeding problems ) from 48.2 to 26.3 ( −45 % ; p<0.001 ) ; ( iii ) low birth weight from 41.9 to 35.2 ( −16 % ; p<0.05 ) ; ( iv ) preterm birth and congenital anomalies remained unchanged . The mean number of morbidities/100 neonates in the 3 years was 228 , 170 and 115 ( a reduction of 49.6 % ; p<0.001 ) . These reductions accompanied an increasing percent score of interventions during 3 years : 37.9 , 58.4 and 81.3 , thus showing a dose – response relationship . In the third year , the proportion of correct maternal knowledge was 78.7 % and behaviours was 69.7 % . The significant seasonal increase earlier observed in the incidence of five morbidities reduced in the third year . CONCLUSION : The home-based care and health education reduced the incidence and burden of neonatal morbidities by nearly half . The effect was broad , but was especially pronounced on infections , care-related morbidities and on the seasonal increase in morbidities 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 compared with the control group . Analysis was by intention to treat . This study is registered as International St and ard R and omised Control Trial , number NCT00198653 . FINDINGS Improvements in birth preparedness , hygienic delivery , thermal care ( including skin-to-skin care ) , umbilical cord care , skin care , and breastfeeding were seen in intervention arms . There was little change in care-seeking . Compared with controls , neonatal mortality rate was reduced by 54 % in the essential newborn-care intervention ( rate ratio 0.46 [ 95 % CI 0.35 - 0.60 ] , p<0.0001 ) and by 52 % in the essential newborn care plus ThermoSpot arm ( 0.48 [ 95 % CI 0.35 - 0.66 ] , p<0.0001 ) . INTERPRETATION A socioculturally context ualised , community-based intervention , targeted at high-risk newborn-care practice s , can lead to substantial behavioural modification and reduction in neonatal mortality . This approach can be applied to behaviour change along the continuum of care , harmonise vertical interventions , and build community capacity for sustained development . FUNDING USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation Abstract Objectives : To evaluate impact of postnatal health education for mothers  on infant care and postnatal family planning practice s in Nepal . Design : R and omised controlled trial with community follow up at 3 and 6 months post partum by interview . Initial household survey of study areas to identify all pregnant women to facilitate follow up . Setting : Main maternity hospital in 
    Output:
    
Home visits for antenatal and neonatal care , together with community mobilization activities , are associated with reduced neonatal mortality and stillbirths in southern Asian setting s with high neonatal mortality and poor access to facility-based health care