RT Journal Article
SR Electronic
T1 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
JF BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001024
DO 10.1136/bmjgh-2018-001024
VO 3
IS 6
A1 Michelle Heys
A1 Lu Gram
A1 Angie Wade
A1 Edward James Norman Haworth
A1 David Osrin
A1 Khadkha Sagar
A1 Dej Krishna Shrestha
A1 Rishi Prasad Neupane
A1 Dhruba Adhikari
A1 Ramesh Kant Adhikari
A1 Bharat Budhathoki
A1 Dharma Manandhar
A1 Anthony Costello
YR 2018
UL http://gh.bmj.com/content/3/6/e001024.abstract
AB 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.