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Objective To conduct the first rigorous evaluation of the long-term effect of the Comprehensive Rural Health Project on childhood mortality in rural Maharashtra. Methods Background information and full birth histories were collected by conducting household surveys and interviewing women. Control villages resembling project villages in terms of population size were randomly selected from an area enclosed by two ellipses centred around, but not including, the project area. An equal number of villages and approximately equal numbers of households and women were randomly sampled from both areas. Cox models with robust standard errors were used to compare the hazard of death among children under 5 years of age in project and control villages. Findings The hazard of death was reduced by 30% (95% confidence interval, Ch 6% to 48%) after the neonatal period in the project villages compared with control villages after adjustment for caste and religion of subjects and for availability of irrigation in the villages. During the neonatal period there was an increase of 3% in the hazard of death, but it was not statistically significant (95% Cl: -18% to 29%). Conclusion Our methods provide useful tools for evaluating long-running community-based primary health care programmes. Our findings add to the growing debate on the long-term sustainability of community- based interventions designed to reduce child mortality. Objectif Mener la premiere evaluation rigoureuse de I'effet a long terme du Projet de Sante Rural Complet sur la mortalite infantile dans la region rurale de Maharashtra. Methodes Les renseignements de base et l'historique complet des accouchements ont ete recueillis en conduisant des sondages aupres des menages et en interrogeant les femmes. Des villages temoins sembiables aux villages du projet en termes de population ont ete selectionnes au hasard dans une region fermee par deux ellipses centrees autour de la region du projet, mais sans la contenir. Un nombre egal de villages et des nombres quasiment egaux de menages et de femmes ont ete echantillonnes au hasard dans les deux regions. Les modeles de Cox erreurs types solides ont ete utilises pour comparer le risque de mortalite chez les enfants de moins de 5 ans dans les villages du projet et dans les villages temoins. Resultats Le risque de deces a diminue de 30% (intervalle de confiance de 95%, IC: 6% a, 48%) apres la periode neo-natale dans les villages du projet compares aux villages temoins apres ajustement en matiere de caste et de religion des sujets, mais aussi en matiere de disponibilite de I'irrigation dans les villages. Une augmentation de 3% du risque de deces a ere enregistree au cours de la periode neo-natale, ce qui n'est pas significatif du point de vue statistique (IC 95%: 18% a 29%). Conclusions Nos methodes fournissent des outils qui permettent d'evaluer les programmes de soins medicaux communautaires primaires qui existent depuis Iongtemps. Nos conclusions s'ajoutent au debat croissant sur la durabilite a long terme des interventions communautaires concues pour reduire la mortalite infantile. Objetivo Llevar a cabo la primera evaluacion rigurosa del efecto a largo plazo del Proyecto Global de Salud Rural sobre mortalidad infantil en las zonas rurales de Maharashtra (India). Metodos Se recopilo informacion general y se elaboro un registro completo de nacimientos mediante la realizacion de encuestas pot hogares y entrevistas a mujeres. Se seleccionaron aleatoriamente aldeas control que se parecian alas aldeas del proyecto en Io que a tamano de poblacion se refiere y que estaban situadas en un area enmarcada por dos elipses con su centro en tomo al area del proyecto, aunque sin incluirla. Se realizo un muestreo aleatorio del mismo numero de aldeas y aproximadamente el mismo numero de hogares de las dos areas. Se utilizaron modelos de Cox con errores estandar robustos para comparar el riesgo instantaneo de muerte entre los ninos menores de 5 anos en las aldeas del proyecto y control. Resultados El riesgo instantaneo de muerte se redujo en un 30% (intervalo de confianza [IC], 95%: 6% al 48%) despues del periodo neonatal en las aldeas del proyecto en comparacion con los pueblos control despues del ajuste por casta y religion de los sujetos y por disponibilidad de irrigacion en las aldeas. Durante el periodo neonatal, se observo un aumento del 3% en el riesgo instantaneo de muerte, pero no era estadisticamente significativo (IC 95%: -18% al 29%). Conclusion Nuestros metodos proporcionan herramientas utiles para evaluar los programas de atencion sanitaria primaria dentro de la comunidad que Ilevan mucho tiempo en funcionamiento. Nuestros resultados se suman al creciente debate sobre la sostenibilidad a largo plazo de las intervenciones en la comunidad disenadas para reducir la mortalidad infantil., Introduction The Bellagio Child Survival Study Group brought the issue of child survival to the forefront of the global health care agenda in 2003 when it reported that 10 million [...]

Background In the mid-2000s, neonatal mortality accounted for almost 40% of deaths of children under 5 years worldwide, and constituted 65% of infant deaths in India. The neonatal mortality rate in Andhra Pradesh was 44 per 1,000 live births, and was higher in the rural areas and tribal regions, such as the Nagarkurnool division of Mahabubnagar district (which became Nagarkurnool district in Telangana in 2014). The aim of the CHAMPION trial was to investigate whether a package of interventions comprising community health promotion and provision of health services (including outreach and facility-based care) could lead to a reduction of the order of 25% in neonatal mortality. Methods and findings The design was a trial in which villages (clusters) in Nagarkurnool with a population < 2,500 were randomised to the CHAMPION package of health interventions or to the control arm (in which children aged 6-9 years were provided with educational interventions-the STRIPES trial). A woman was eligible for the CHAMPION package if she was married and Conclusions The CHAMPION trial showed that a package of interventions addressing health knowledge and health seeking behaviour, buttressing existing health services, and contracting out important areas of maternal and child healthcare led to a reduction in neonatal mortality of almost the hypothesized 25% in small villages in an Indian state with high mortality rates. The intervention can be strongly justified in much of rural India, and is of potential use in other similar settings. Ongoing changes in maternal and child health programmes make it imperative that a similar intervention that establishes ties between the community and health facilities is tested in different settings. Trial registration ISRCTN registry ISRCTN24104646, Author(s): Peter Boone 1, Alex Eble 1,2, Diana Elbourne 3,*, Chris Frost 3, Chitra Jayanty 1, Rashmi Lakshminarayana 1,4, Vera Mann 3,5, Rohini Mukherjee 6, Gilda Piaggio 3,7, Padmanabh Reddy [...]

Abstract Background Performance of primary school students in India lags far below government expectations, and major disparity exists between rural and urban areas. The Naandi Foundation has designed and implemented a programme using community members to deliver after-school academic support for children in over 1,100 schools in five Indian states. Assessments to date suggest that it might have a substantial effect. This trial aims to evaluate the impact of this programme in villages of rural Andhra Pradesh and will compare test scores for children in three arms: a control and two intervention arms. In both intervention arms additional after-school instruction and learning materials will be offered to all eligible children and in one arm girls will also receive an additional 'kit' with a uniform and clothes. Methods/Design The trial is a cluster-randomised controlled trial conducted in conjunction with the CHAMPION trial. In the CHAMPION trial 464 villages were randomised so that half receive health interventions aiming to reduce neonatal mortality. STRIPES will be introduced in those CHAMPION villages which have a public primary school attended by at least 15 students at the time of a baseline test in 2008. 214 villages of the 464 were found to fulfil above criteria, 107 belonging to the control and 107 to the intervention arm of the CHAMPION trial. These latter 107 villages will serve as control villages in the STRIPES trial. A further randomisation will be carried out within the 107 STRIPES intervention villages allocating half to receive an additional kit for girls on the top of the instruction and learning materials. The primary outcome of the trial is a composite maths and language test score. Discussion The study is designed to measure (i) whether the educational intervention affects the exam score of children compared to the control arm, (ii) if the exam scores of girls who receive the additional kit are different from those of girls living in the other STRIPES intervention arm. One of the goals of the STRIPES trial is to provide benefit to the controls of the CHAMPION trial. We will also conduct a cost-benefit analysis in which we calculate the programme cost for 0.1 standard deviation improvement for both intervention arms. Trial Registration Current controlled trials ISRCTN69951502

Background: Performance of primary school students in India lags far below government expectations, and major disparity exists between rural and urban areas. The Naandi Foundation has designed and implemented a programme using community members to deliver after-school academic support for children in over 1,100 schools in five Indian states. Assessments to date suggest that it might have a substantial effect. This trial aims to evaluate the impact of this programme in villages of rural Andhra Pradesh and will compare test scores for children in three arms: a control and two intervention arms. In both intervention arms additional after-school instruction and learning materials will be offered to all eligible children and in one arm girls will also receive an additional 'kit' with a uniform and clothes., Methods/design: The trial is a cluster-randomised controlled trial conducted in conjunction with the CHAMPION trial. In the CHAMPION trial 464 villages were randomised so that half receive health interventions aiming to reduce neonatal mortality. STRIPES will be introduced in those CHAMPION villages which have a public primary school attended by at least 15 students at the time of a baseline test in 2008. 214 villages of the 464 were found to fulfil above criteria, 107 belonging to the control and 107 to the intervention arm of the CHAMPION trial. These latter 107 villages will serve as control villages in the STRIPES trial. A further randomisation will be carried out within the 107 STRIPES intervention villages allocating half to receive an additional kit for girls on the top of the instruction and learning materials. The primary outcome of the trial is a composite maths and language test score., Discussion: The study is designed to measure (i) whether the educational intervention affects the exam score of children compared to the control arm, (ii) if the exam scores of girls who receive the additional kit are different from those of girls living in the other STRIPES intervention arm. One of the goals of the STRIPES trial is to provide benefit to the controls of the CHAMPION trial. We will also conduct a cost-benefit analysis in which we calculate the programme cost for 0.1 standard deviation improvement for both intervention arms., Trial Registration: Current controlled trials ISRCTN69951502.