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Progress towards the Millennium Development Goals for maternal and child mortality has faltered. Most neonatal deaths happen at home and are avoidable. But healthcare systems have trouble reaching poor rural residents. In rural Nepal, participatory women’s groups are reducing neonatal mortality by 30 percent.

Of the world’s four million neonatal (first 4 weeks after birth) deaths each year, 98 percent occur in developing countries. Nepal is a poor country where geography and political instability increase development challenges. The maternal mortality ratio is around 539 per 100,000 live births and the infant mortality rate approximately 64 per 100 live births. In rural areas, 94 percent of babies are born at home and only 13 percent of these births are attended by trained health workers.

Researchers from Mother and Infant Research Activities (MIRA), Nepal, and the UK Institute of Child Health, University of London, randomly divided 12 pairs of village clusters in Nepal’s Makwanpur district into either control or test groups. In each cluster of villages (average population 7,000) a female facilitator set up nine women’s group meetings each month. The groups used an action-learning cycle (doing, observing, thinking and designing) to identify local perinatal problems and to devise strategies to solve them. The researchers looked at birth outcomes among 28,931 women, of whom 8 percent had joined the groups.

They found that:

• Groups attracted 37 percent of newly-pregnant women and members raised awareness of perinatal issues with other women in the community.
• The neonatal mortality rate was 26.2 per 1,000 live births in test villages, compared with 36.9 per 1,000 in controls. Stillbirth rates were similar in both groups.
• The maternal mortality ratio was 69 per 100,000 live births in test villages, compared with 341 per 100,000 in controls.
• Women in test villages were more likely than controls to have antenatal care, deliver at a health facility, and have a trained health worker present at the birth, using hygienic practices.
• 95 percent of the groups remained active at the end of the trial, despite no financial incentive and the costs to women of spending time away from other tasks.

The cost per disability adjusted year of US$ 111 compares well with the World Bank’s definition of less than US$ 127 per disability-adjusted life year (DALY) saved as ‘cost-effective’. The strategy could benefit other health issues such as nutrition, stillbirths, infant and childhood mortality, and malaria and HIV infection in pregnancy.

The researchers conclude that the model could be quickly extended and used elsewhere. This would require:

• investment
• political commitment
• action by both government and non-governmental organisations
• close collaboration with the health sector.

Source: id21

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