Background: Maternal and neonatal mortality are high in Malawi, and cost-effective
and sustainable interventions are needed in order to reduce mortality rates and make
progress to achieve Millennium Development Goals 4 and 5 for mother and child
health. Where health systems are weak and many women deliver at home, community-based
interventions have the potential to make an important contribution to health
improvements.
Methods: A cluster-randomised study with a factorial design was used to evaluate the
impact of two community-based interventions on maternal and child health outcomes. A
prospective pregnancy and birth monitoring system was developed to collect
information on pre-specified pregnancy, birth and infant outcomes. The research
presented here focuses on the women’s group intervention, which uses participatory
methods to mobilise communities to take actions for maternal and child health problems
they identify.
Results: 18,562 pregnancies were followed up, resulting in 18,340 live births, 362
stillbirths, 434 neonatal deaths and 73 maternal deaths. 11,450 live births were
identified retrospectively, resulting in 484 infant deaths. Statistically significant
reductions in maternal and neonatal mortality as a result of the women’s group
intervention were not seen (adjusted odds ratio 0.94 (95% CI 0.56-1.61) and 0.95 (95%
CI 0.71-1.28) respectively). There were significant improvements in antenatal care and
immunisation, and reductions in births attended by traditional birth attendants, and there
were non-significant reductions in mortality and increases in health-care seeking.
Discussion:
Although women’s groups showed promising signs of community-level action for
mother and child health, methodological factors, such as low power and baseline
imbalance after randomisation, may have limited the ability of this study to detect an
impact of the intervention on mother and child health outcomes. Design and
implementation factors may also have caused delays and limited the measurable impact
of the intervention at this time. Follow-up over a longer period may show greater
impact
