Study protocol

Cluster-randomised controlled trial of community mobilisation in Mumbai slums to improve care during pregnancy, delivery, postpartum and for the newborn

Neena Shah More¹ , Ujwala Bapat¹ , Sushmita Das¹ , Sarita Patil¹ , Maya Porel¹ , Leena Vaidya¹ , Bhaveshree Koriya¹ , Sarah Barnett² , Anthony Costello² , Armida Fernandez¹ and David Osrin²

¹  Society for Nutrition, Education and Health Action (SNEHA), Urban Health Centre, Chota Sion Hospital, 60 Feet Road, Shahunagar, Dharavi, Mumbai 400017, Maharashtra, India

²  UCL Centre for International Health and Development, Institute of Child Health, 30 Guilford St, London WC1N 1EH, UK

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Trials 2008, 9:7doi:10.1186/1745-6215-9-7

Published:	10 February 2008

Abstract

Background

The United Nations Millennium Development Goals look to substantial improvements in child and maternal survival. Morbidity and mortality during pregnancy, delivery and the postnatal period are prime obstacles to achieving these goals. Given the increasing importance of urban health to global prospects, Mumbai's City Initiative for Newborn Health aims to improve maternal and neonatal health in vulnerable urban slum communities, through a combination of health service quality improvement and community participation. The protocol describes a trial of community intervention aimed at improving prevention, care seeking and outcomes.

Objective

To test an intervention that supports local women as facilitators in mobilising communities for better health care. Community women's groups will build an understanding of their potential to improve maternal and infant health, and develop and implement strategies to do so.

Design

Cluster-randomized controlled trial.

Methods

The intervention will employ local community-based female facilitators to convene groups and help them to explore maternal and neonatal health issues. Groups will meet fortnightly through a seven-phase process of sharing experiences, discussion of the issues raised, discovery of potential community strengths, building of a vision for action, design and implementation of community strategies, and evaluation.

The unit of allocation will be an urban slum cluster of 1000–1500 households. 48 clusters have been randomly selected after stratification by ward. 24 clusters have been randomly allocated to receive the community intervention. 24 clusters will act as control groups, but will benefit from health service quality improvement. Indicators of effect will be measured through a surveillance system implemented by the project. Key distal outcome indicators will be neonatal mortality and maternal and neonatal morbidity. Key proximate outcome indicators will be home care practices, uptake of antenatal, delivery and postnatal care, and care for maternal and neonatal illness.

Data will be collected through a vital registration system for births and deaths in the 48 study clusters. Structured interviews with families will be conducted at about 6 weeks after index deliveries. We will also collect both quantitative and qualitative data to support a process evaluation.

Trial registration

Current controlled trials ISRCTN96256793