Omrana Pasha, et al. “Communities, Birth Attendants and Health Facilities: A Continuum of Emergency Maternal and Newborn Care (The Global Network’s EmONC Trial).” BMC Pregnancy & Childbirth 10, no. 82 (December 14, 2010).

URL: www.biomedcentral.com/1471-2393/10/82

Abstract

Background: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes.

Methods/Design: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women’s and Children’s Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality.

Pasha et al., present the design of a large cluster-randomized control trial intended to evaluate the impact of community mobilization, birth attendant training, and quality improvement at health care facilities on pregnancy outcomes in Argentina, Guatemala, India, Kenya, Pakistan, and Zambia. Many of these interventions are thought to improve maternal and neonatal survival, but the data confirming their efficacy is scarce.  The authors aim for the results of this trial to inform policymakers and donors as they develop strategies to improve maternal and neonatal survival worldwide.