Effects of Women's Groups Practising Participatory Learning and Action on Preventive and Care-Seeking Behaviours to Reduce Neonatal Mortality: A Meta-Analysis of Cluster-Randomised Trials

Responding to "calls to understand the pathways through which [the participatory learning and action (PLA)] community intervention may affect neonatal mortality, ...[researchers] examined the effect of women´s groups on key antenatal, delivery, and postnatal behaviours in order to understand pathways to mortality reduction."

Using a meta-analysis based upon 7 cluster-randomised controlled trials that took place between 2001 and 2012, this research group estimated the effect of the women´s group intervention on behavioural outcomes including: appropriate antenatal care, facility delivery, use of a safe delivery kit, hand washing by the birth attendant prior to delivery, use of a sterilised instrument to cut the umbilical cord, immediate wrapping of the newborn after delivery, delayed bathing of the newborn, early initiation of breastfeeding, and exclusive breastfeeding. The studies included participants ranging between 6,125 and 29,901 live births in the following locations: rural India, urban India, rural Bangladesh, rural Nepal, and rural Malawi.

"In the first stage, we used random effects models with individual patient data to assess the effect of groups on outcomes separately for the different trials. In the second stage of the meta-analysis, random effects models were applied using summary-level estimates calculated in the first stage of the analysis. To determine whether behaviour change was related to group attendance, we used random effects models to assess associations between outcomes and the following categories of group attendance and allocation: women attending a group and allocated to the intervention arm; women not attending a group but allocated to the intervention arm; and women allocated to the control arm."

Variations in local practices affected results, for example, in Malawi, the project focused on facility-based deliveries to the exclusion of discussing clean delivery and birth attendant training. The analysis was of either studies that used a baseline or a control arm. Individual birth records were assessed and the randomised effects models were used in the second stage.

It was found that women's groups practising PLA improved behaviours during and after home deliveries, especially in the behaviours of using safe delivery kits, cutting the cord with a sterile blade, hand washing prior to delivery, delayed bathing of newborn, and wrapping of newborn. Evidence was not found for improved uptake of facility delivery, breastfeeding within an hour or exclusively for 6 weeks, and antenatal care.

"Future research could address the mechanisms behind how PLA improves survival, in order to adapt this method to improve maternal and newborn health in different contexts, as well as improve other outcomes across the continuum of care for women, children, and adolescents."