Measuring What Works: An Impact Evaluation of Women's Groups on Maternal Health Uptake in Rural Nepal.

BACKGROUND: There is a need for studies evaluating maternal health interventions in low-income countries. This paper evaluates one such intervention designed to promote maternal health among rural women in Nepal. METHODS AND RESULTS: This was a five-year controlled, non-randomised, repeated cross-sectional study (2007, 2010, 2012) of a participatory community-based maternal health promotion intervention focusing on women's groups to improve maternal health services uptake. In total 1,236 women of childbearing age, who had their last child ≤ two years ago, were interviewed. Difference-in-Difference estimation assessed the effects of the intervention on selected outcome variables while controlling for a constructed wealth index and women's characteristics. In the first three years (from 2007 to the 2010), the intervention increased women's likelihood of attending for antenatal care at least once during pregnancy by seven times [OR = 7.0, 95%CI (2.3; 21.4)], of taking iron and folic acid by three times [OR = 3.0, 95%CI (1.2; 7.8)], and of seeking four or more antenatal care visits of two times, although not significantly [OR = 2.2, 95%CI (1.0; 4.7)]. Over five years, women were more likely to seek antenatal care at least once [OR = 3.0, 95%CI (1.5; 5.2)], to take iron/folic acid [OR = 1.9, [95% CI (1.1; 3.2)], and to attend postnatal care [OR = 1.5, [95% CI (1.1; 2.2)]. No improvement was found on attending antenatal care in the first trimester, birthing at an institution or with a skilled birth attendant. CONCLUSION: Community-based health promotion has a much stronger effect on the uptake of antenatal care and less on delivery care. Other factors not easily resolved through health promotion interventions may influence these outcomes, such as costs or geographical constraints. The evaluation has implications for policy and practice in public health, especially maternal health promotion

Relationship of work schedules to gastrointestinal diagnoses, symptoms, and medication use in auto factory workers

Background Gastrointestinal (GI) complaints are common in shift workers. This study examines the relationship between work schedules and GI symptoms, medications, and diagnoses. Methods In a cross-sectional survey of 343 US auto factory workers, four work schedule variables were examined: assigned shift, number of hours worked, number of night hours, and schedule variability. Multiple regression tested the relationship between GI outcomes and work schedule variables while controlling for covariates. Results The evening shift was associated with more GI symptoms and GI diagnoses. Unexpectedly, more consistent work times were associated with having a GI diagnosis. As schedule variability increased the probability of GI medication use increased in low noise exposure. Conclusion Findings suggest that evening shift and widely varying work start and end times may increase risks for GI disturbances. Am. J. Ind. Med. 46:586–598, 2004. © 2004 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34826/1/20099_ftp.pd