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Long-term impact of community-based participatory women’s groups on child and maternal mortality and child disability: follow-up of a cluster randomised trial in rural Nepal
  1. Michelle Heys1,2,
  2. Lu Gram1,
  3. Angie Wade2,
  4. Edward James Norman Haworth2,
  5. David Osrin1,
  6. Khadkha Sagar3,
  7. Dej Krishna Shrestha3,4,
  8. Rishi Prasad Neupane3,
  9. Dhruba Adhikari3,
  10. Ramesh Kant Adhikari3,
  11. Bharat Budhathoki3,
  12. Dharma Manandhar3,
  13. Anthony Costello1
  1. 1 UCL Institute for Global Health, University College London, London, UK
  2. 2 Great Ormond Street Institute of Child Health, University College London, London, UK
  3. 3 Mother and Infant Research Activities (MIRA), Kathmandu, Nepal
  4. 4 Health Systems Unit, WHO Country Office for Nepal, Kathmandu, Nepal
  1. Correspondence to Dr Michelle Heys; m.heys{at}


Background Community-based women’s groups practising participatory learning and action (PLA) can reduce maternal and neonatal mortality in low-income countries. However, it is not clear whether these reductions are associated with subsequent increased or decreased rates of childhood death and disability. We assessed the impact on child deaths and disability beyond the perinatal period among participants in the earliest trial in Nepal 2001–2003.

Methods Household interviews were conducted with mothers or household heads. At cluster and individual levels, we analysed disability using pairwise log relative risks and survival using multilevel logistic models.

Findings From 6075 children and 6117 mothers alive at 4 weeks post partum, 44 419 children (73%) were available for interview a mean 11.5 years later. Rates of child deaths beyond the perinatal period were 36.6 and 52.0 per 1000 children in the intervention and control arms respectively. Rates of disability were 62.7 and 85.5 per 1000 children in the intervention and control arms respectively. Individual-level analysis, including random effects for cluster pairing and adjusted for baseline maternal literacy, socioeconomic status and maternal age, showed lower, statistically non-significant, odds of child deaths (OR 0.70 (95% CI 0.43 to 1.18) and disability (0.64 (0.39 to 1.06)) in the intervention arm.

Conclusion Community-level exposure to women’s groups practising PLA did not significantly impact childhood death or disability or death beyond the perinatal period. Follow-up of other trials with larger sample sizes is warranted in order to explore the possibility of potential long-term survival and disability benefits with greater precision.

  • child mortality
  • maternal mortality
  • developmental disabilities
  • Nepal
  • observational study

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  • Handling editor Seye Abimbola

  • Contributors MH: led the conception and design of the work, acquisition, analysis and interpretation of data and drafted, edited and approved the manuscript. AC: contributed to conception and design of the work, interpretation of data and revision of the manuscript. LG, AW: made substantial contributions to the analysis and interpretation of data and drafting of the work. EJNH: contributed to the analysis of data and revised the manuscript critically for important intellectual content. DO: made substantial contribution to the interpretation of data and the intellectual content and drafting of the manuscript. KS, DKS, RKA, BB: made substantial contributions to the acquisition of data and study design. DM: contributed key intellectual input to study design and data acquistion and interpretation. All authors approved the final manuscript.

  • Funding During the conduct of this study MH was funded as an Academic Clinical Lecturer by the National Institute for Health Research, UK (CL-2010-18-007). The follow-up study fieldwork was funded by the Wellcome Trust (Reference Number 085417/Z/08/Z). DO is funded by the Wellcome Trust (206417/Z/17/Z).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval for the original trial was obtained from the Nepal Health Research Council and the ethics committee of the Institute of Child Health and Great Ormond Street Hospital for Children. Ethical approval for the follow-up study was obtained from the Nepal Health Research Council ( and the University College London Research Ethics Committee (Project ID: 5143/002).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No data are currently publicly available.

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