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Previous Volume 352:2091-2099 May 19, 2005 Number 20 Next

	Full Text PDF PDA Full Text Perspective by Zupan, J. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries.

Methods We performed a cluster-randomized, controlled trial involving seven subdistricts (talukas) of a rural district in Pakistan. In three talukas randomly assigned to the intervention group, traditional birth attendants were trained and issued disposable delivery kits; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes; and obstetrical teams provided outreach clinics for antenatal care. Women in the four control talukas received usual care. The primary outcome measures were perinatal and maternal mortality.

Results Of the estimated number of eligible women in the seven talukas, 10,114 (84.3 percent) were recruited in the three intervention talukas, and 9443 (78.7 percent) in the four control talukas. In the intervention group, 9184 women (90.8 percent) received antenatal care by trained traditional birth attendants, 1634 women (16.2 percent) were seen antenatally at least once by the obstetrical teams, and 8172 safe-delivery kits were used. As compared with the control talukas, the intervention talukas had a cluster-adjusted odds ratio for perinatal death of 0.70 (95 percent confidence interval, 0.59 to 0.82) and for maternal mortality of 0.74 (95 percent confidence interval, 0.45 to 1.23).

Conclusions Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality. This model could result in large improvements in perinatal and maternal health in developing countries.

Source Information

From Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan (A.H.J.); and the Department of Public Health and Epidemiology, University of Birmingham, Birmingham, U.K. (A.H.J., H.R.W., K.K.C.).

Address reprint requests to Dr. Jokhio at Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan, or at jokhiohl{at}super.net.pk.

Full Text of this Article

Related Letters:

An Intervention Involving Traditional Birth Attendants in Pakistan
Davis J. B., Jokhio A. H., Winter H. R., Cheng K. K.
Extract | Full Text | PDF  
N Engl J Med 2005; 353:1417-1418, Sep 29, 2005. Correspondence

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