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Women's groups prac...
Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings : a systematic review and meta-analysis
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Prost, Audrey (author)
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Colbourn, Tim (author)
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Seward, Nadine (author)
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show more...
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Azad, Kishwar (author)
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Coomarasamy, Arri (author)
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Copas, Andrew (author)
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Houweling, Tanja A J (author)
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Fottrell, Edward (author)
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Kuddus, Abdul (author)
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Lewycka, Sonia (author)
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MacArthur, Christine (author)
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Manandhar, Dharma (author)
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Morrison, Joanna (author)
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Mwansambo, Charles (author)
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Nair, Nirmala (author)
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Nambiar, Bejoy (author)
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Osrin, David (author)
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Pagel, Christina (author)
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Phiri, Tambosi (author)
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Pulkki-Brännström, Anni-Maria (author)
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Rosato, Mikey (author)
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Skordis-Worrall, Jolene (author)
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Saville, Naomi (author)
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More, Neena Shah (author)
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Shrestha, Bhim (author)
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Tripathy, Prasanta (author)
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Wilson, Amie (author)
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Costello, Anthony (author)
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- 2013
- 2013
- English.
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In: The Lancet. - 0140-6736 .- 1474-547X. ; 381:9879, s. 1736-46
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
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- BACKGROUND: Maternal and neonatal mortality rates remain high in many low-income and middle-income countries. Different approaches for the improvement of birth outcomes have been used in community-based interventions, with heterogeneous effects on survival. We assessed the effects of women's groups practising participatory learning and action, compared with usual care, on birth outcomes in low-resource settings.METHODS: We did a systematic review and meta-analysis of randomised controlled trials undertaken in Bangladesh, India, Malawi, and Nepal in which the effects of women's groups practising participatory learning and action were assessed to identify population-level predictors of effect on maternal mortality, neonatal mortality, and stillbirths. We also reviewed the cost-effectiveness of the women's group intervention and estimated its potential effect at scale in Countdown countries.FINDINGS: Seven trials (119,428 births) met the inclusion criteria. Meta-analyses of all trials showed that exposure to women's groups was associated with a 37% reduction in maternal mortality (odds ratio 0.63, 95% CI 0.32-0.94), a 23% reduction in neonatal mortality (0.77, 0.65-0.90), and a 9% non-significant reduction in stillbirths (0.91, 0.79-1.03), with high heterogeneity for maternal (I(2)=58.8%, p=0.024) and neonatal results (I(2)=64.7%, p=0.009). In the meta-regression analyses, the proportion of pregnant women in groups was linearly associated with reduction in both maternal and neonatal mortality (p=0.026 and p=0.011, respectively). A subgroup analysis of the four studies in which at least 30% of pregnant women participated in groups showed a 55% reduction in maternal mortality (0.45, 0.17-0.73) and a 33% reduction in neonatal mortality (0.67, 0.59-0.74). The intervention was cost effective by WHO standards and could save an estimated 283,000 newborn infants and 41,100 mothers per year if implemented in rural areas of 74 Countdown countries.INTERPRETATION: With the participation of at least a third of pregnant women and adequate population coverage, women's groups practising participatory learning and action are a cost-effective strategy to improve maternal and neonatal survival in low-resource settings.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Hälsovetenskap -- Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Health Sciences -- Public Health, Global Health, Social Medicine and Epidemiology (hsv//eng)
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The Lancet
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Prost, Audrey
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Colbourn, Tim
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Seward, Nadine
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Azad, Kishwar
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Coomarasamy, Arr ...
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Copas, Andrew
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show more...
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Houweling, Tanja ...
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Fottrell, Edward
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Kuddus, Abdul
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Lewycka, Sonia
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MacArthur, Chris ...
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Manandhar, Dharm ...
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Morrison, Joanna
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Mwansambo, Charl ...
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Nair, Nirmala
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Nambiar, Bejoy
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Osrin, David
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Pagel, Christina
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Phiri, Tambosi
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Pulkki-Brännströ ...
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Rosato, Mikey
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Skordis-Worrall, ...
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Saville, Naomi
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More, Neena Shah
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Shrestha, Bhim
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Tripathy, Prasan ...
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Wilson, Amie
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Costello, Anthon ...
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MEDICAL AND HEAL ...
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The Lancet
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Umeå University