Explaining the impact of a women's group led community mobilisation intervention on maternal and newborn health outcomes: the Ekjut trial process evaluation

BMC International Health and Human Rights

Research Article

Prasanta K Tripathy¹  Rajendra Mahapatra¹  Nirmala Nair¹  Aparna Bajpai¹  Shibanand Rath¹  Suchitra Rath¹  Rajkumar Gope¹  Rajesh Sinha¹  Audrey Prost²  Sarah Barnett²  Anthony Costello² 

[1] Ekjut, Ward No-17, Plot 556B, Potka, Po-Chakradharpur, Pin- 833102, Dist. West Singhbhum., Jharkhand, India;UCL Centre for International Health and Development, Institute of Child Health, University College London, 30 Guilford Street, WC1N 1EH, London, UK;

关键词: Neonatal Mortality;    Community Health Worker;    Intervention Cluster;    Participatory Intervention;    Critical Consciousness;   

DOI  :  10.1186/1472-698X-10-25

 received in 2010-04-05, accepted in 2010-10-22,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundFew large and rigorous evaluations of participatory interventions systematically describe their context and implementation, or attempt to explain the mechanisms behind their impact. This study reports process evaluation data from the Ekjut cluster-randomised controlled trial of a participatory learning and action cycle with women's groups to improve maternal and newborn health outcomes in Jharkhand and Orissa, eastern India (2005-2008). The study demonstrated a 45% reduction in neonatal mortality in the last two years of the intervention, largely driven by improvements in safe practices for home deliveries.MethodsA participatory learning and action cycle with 244 women's groups was implemented in 18 intervention clusters covering an estimated population of 114 141. We describe the context, content, and implementation of this intervention, identify potential mechanisms behind its impact, and report challenges experienced in the field. Methods included a review of intervention documents, qualitative structured discussions with group members and non-group members, meeting observations, as well as descriptive statistical analysis of data on meeting attendance, activities, and characteristics of group attendees.ResultsSix broad, interrelated factors influenced the intervention's impact: (1) acceptability; (2) a participatory approach to the development of knowledge, skills and 'critical consciousness'; (3) community involvement beyond the groups; (4) a focus on marginalized communities; (5) the active recruitment of newly pregnant women into groups; (6) high population coverage. We hypothesize that these factors were responsible for the increase in safe delivery and care practices that led to the reduction in neonatal mortality demonstrated in the Ekjut trial.ConclusionsParticipatory interventions with community groups can influence maternal and child health outcomes if key intervention characteristics are preserved and tailored to local contexts. Scaling-up such interventions requires (1) a detailed understanding of the way in which context affects the acceptability and delivery of the intervention; (2) planned but flexible replication of key content and implementation features; (3) strong support for participatory methods from implementing agencies.

【 授权许可】

Unknown   
© Rath et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.