PMID- 32375684 OWN - NLM STAT- MEDLINE DCOM- 20210125 LR - 20210125 IS - 1471-2393 (Electronic) IS - 1471-2393 (Linking) VI - 20 IP - 1 DP - 2020 May 6 TI - Health management committee strengthening and community mobilisation through women's groups to improve trained health worker attendance at birth in rural Nepal: a cluster randomised controlled trial. PG - 268 LID - 10.1186/s12884-020-02960-6 [doi] LID - 268 AB - BACKGROUND: Engaging citizens and communities to make services accountable is vital to achieving health development goals. Community participation in health management committees can increase public accountability of health services. We conducted a cluster randomised controlled trial to test the impact of strengthened health management committees (HMCs) and community mobilisation through women's groups on institutional deliveries and deliveries by trained health workers in rural Nepal. METHODS: The study was conducted in all Village Development Committee clusters in the hills district of Makwanpur (population of 420,500). In 21 intervention clusters, we conducted three-day workshops with HMCs to improve their capacity for planning and action and supported female community health volunteers to run women's groups. These groups met once a month and mobilised communities to address barriers to institutional delivery through participatory learning and action cycles. We compared this intervention with 22 control clusters. Prospective surveillance from October 2010 to the end of September 2012 captured complete data on 13,721 deliveries in intervention and control areas. Analysis was by intention to treat. RESULTS: The women's group intervention was implemented as intended, but we were unable to support HMCs as planned because many did not meet regularly. The activities of community based organisations were systematically targeted at control clusters, which meant that there were no true 'control' clusters. 39% (5403) of deliveries were in health institutions and trained health workers attended most of them. There were no differences between trial arms in institutional delivery uptake (1.45, 0.76-2.78) or attendance by trained health workers (OR 1.43, 95% CI 0.74-2.74). CONCLUSIONS: The absence of a true counterfactual and inadequate coverage of the HMC strengthening intervention impedes our ability to draw conclusions. Further research is needed to test the effectiveness of strengthening public accountability mechanisms on increased utilisation of services at delivery. TRIAL REGISTRATION: Current Controlled Trials ISRCTN99834806. Date of registration:28/09/10. FAU - Morrison, Joanna AU - Morrison J AUID- ORCID: 0000-0002-9241-8863 AD - Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. Joanna.morrison@ucl.ac.uk. FAU - Tumbahangphe, Kirti AU - Tumbahangphe K AD - Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal. FAU - Sen, Aman AU - Sen A AD - Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal. FAU - Gram, Lu AU - Gram L AD - Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. FAU - Budhathoki, Bharat AU - Budhathoki B AD - Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal. FAU - Neupane, Rishi AU - Neupane R AD - Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal. FAU - Thapa, Rita AU - Thapa R AD - Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal. FAU - Dahal, Kunta AU - Dahal K AD - Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal. FAU - Thapa, Bidur AU - Thapa B AD - Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal. FAU - Manandhar, Dharma AU - Manandhar D AD - Mother and Infant Research Activities, PO Box 921, Thapathali, Kathmandu, Nepal. FAU - Costello, Anthony AU - Costello A AD - Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. FAU - Osrin, David AU - Osrin D AD - Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK. LA - eng GR - 085417MA/Z/08/Z/WT_/Wellcome Trust/United Kingdom PT - Journal Article PT - Randomized Controlled Trial DEP - 20200506 PL - England TA - BMC Pregnancy Childbirth JT - BMC pregnancy and childbirth JID - 100967799 SB - IM MH - Adolescent MH - Adult MH - Child MH - Cluster Analysis MH - Community Health Workers/*education MH - Community Participation/*methods MH - Delivery, Obstetric/*education MH - Developing Countries MH - Female MH - Health Services Accessibility/statistics & numerical data MH - Humans MH - Maternal Health Services MH - Middle Aged MH - Nepal MH - Pregnancy MH - Prospective Studies MH - *Rural Population MH - *Women MH - Young Adult PMC - PMC7201973 OTO - NOTNLM OT - Health systems OT - Maternal OT - Newborn OT - Participation OT - Public accountability OT - South Asia COIS- The authors declare that they have no competing interests. EDAT- 2020/05/08 06:00 MHDA- 2021/01/26 06:00 PMCR- 2020/05/06 CRDT- 2020/05/08 06:00 PHST- 2018/09/17 00:00 [received] PHST- 2020/04/21 00:00 [accepted] PHST- 2020/05/08 06:00 [entrez] PHST- 2020/05/08 06:00 [pubmed] PHST- 2021/01/26 06:00 [medline] PHST- 2020/05/06 00:00 [pmc-release] AID - 10.1186/s12884-020-02960-6 [pii] AID - 2960 [pii] AID - 10.1186/s12884-020-02960-6 [doi] PST - epublish SO - BMC Pregnancy Childbirth. 2020 May 6;20(1):268. doi: 10.1186/s12884-020-02960-6.