1. Community level interventions for pre-eclampsia (CLIP) in India: A cluster randomised controlled trial
- Author
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Joel Singer, Laura A. Magee, Avinash Kavi, Sumedha Sharma, Shivaprasad S. Goudar, Peter von Dadelszen, Umesh Ramadurg, Jeffrey N Bone, Dustin Dunsmuir, Beth A. Payne, Marianne Vidler, Ashalata Mallapur, Mrutunjaya B Bellad, Hubert Wong, Richard J. Derman, Jing Li, Amit P. Revankar, Chandrashekhar Karadiguddi, Narayan V Honnungar, Umesh Charantimath, Zulfiqar A Bhutta, Domena Tu, Hannah L. Nathan, Geetanjali Katageri, Andrew Shennan, J. Mark Ansermino, Bhalachandra S. Kodkany, and Tang Lee
- Subjects
Gestational hypertension ,Adult ,medicine.medical_specialty ,Community health worker ,Referral ,Adolescent ,Psychological intervention ,India ,Article ,Cluster randomized controlled trial ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Internal Medicine ,Medicine ,Humans ,030212 general & internal medicine ,Cluster randomised controlled trial ,Mobile health ,Community Health Services ,030219 obstetrics & reproductive medicine ,Eclampsia ,business.industry ,Community engagement ,Infant, Newborn ,Pregnancy Outcome ,Obstetrics and Gynecology ,Odds ratio ,Pregnancy hypertension ,Middle Aged ,medicine.disease ,Triage ,Confidence interval ,Emergency medicine ,Female ,business - Abstract
Highlights • As implemented, the CLIP intervention did not improve the primary composite outcome. • ASHAs and ANMs were able to undertake all aspects of the mobile health app-guided visits. • Women could not be reached in their communities as frequently as planned. • Eight or more POM-guided contacts were associated with fewer stillbirths supporting WHO guidance. • Community-level interventions are unlikely to improve outcomes without enhanced facility care., Objectives Pregnancy hypertension is associated with 7.1% of maternal deaths in India. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment. Study design The Indian Community-Level Interventions for Pre-eclampsia (CLIP) open-label cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 clusters (initial four-cluster internal pilot) in Belagavi and Bagalkote, Karnataka. The CLIP intervention (6 clusters) consisted of community engagement, community health workers (CHW) provided mobile health (mHeath)-guided clinical assessment, initial treatment, and referral to facility either urgently (
- Published
- 2020