Ontology highlight
ABSTRACT:
Study design: In the Pakistan Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial (NCT01911494), LHWs engaged the community, recruited pregnant women from 20 union councils (clusters), undertook mobile health-guided clinical assessment for preeclampsia, and referral to facilities after stabilization.
Main outcome measures: The primary outcome was a composite of maternal, fetal and newborn mortality and major morbidity.
Findings: We recruited 39,446 women in intervention (N = 20,264) and control clusters (N = 19,182) with minimal loss to follow-up (3?7% vs. 4?5%, respectively). The primary outcome did not differ between intervention (26·6%) and control (21·9%) clusters (adjusted odds ratio, aOR, 1?20 [95% confidence interval 0?84-1?72]; p = 0?31). There was reduction in stillbirths (0·89 [0·81-0·99]; p = 0·03), but no impact on maternal death (1·08 [0·69, 1·71]; p = 0·74) or morbidity (1·12 [0·57, 2·16]; p = 0·77); early (0·95 [0·82-1·09]; p = 0·46) or late neonatal deaths (1·23 [0·97-1·55]; p = 0·09); or neonatal morbidity (1·22 [0·77, 1·96]; p = 0·40). Improvements in outcome rates were observed with 4-7 (p = 0·015) and ?8 (p < 0·001) (vs. 0) CLIP contacts.
Interpretation: The CLIP intervention was well accepted by the community and implemented by LHWs. Lack of effects on adverse outcomes could relate to quality care for mothers with pre-eclampsia in health facilities. Future strategies for community outreach must also be accompanied by health facility strengthening.
Funding: The University of British Columbia (PRE-EMPT), a grantee of the Bill & Melinda Gates Foundation (OPP1017337).
SUBMITTER: Qureshi RN
PROVIDER: S-EPMC7694879 | biostudies-literature | 2020 Oct
REPOSITORIES: biostudies-literature
Qureshi Rahat N RN Sheikh Sana S Hoodbhoy Zahra Z Sharma Sumedha S Vidler Marianne M Payne Beth A BA Ahmed Imran I Mark Ansermino J J Bone Jeffrey J Dunsmuir Dustin T DT Lee Tang T Li Jing J Nathan Hannah L HL Shennan Andrew H AH Singer Joel J Tu Domena K DK Wong Hubert H Magee Laura A LA von Dadelszen Peter P Bhutta Zulfiqar A ZA
Pregnancy hypertension 20200728
<h4>Objectives</h4>To reduce all-cause maternal and perinatal mortality and major morbidity through Lady Health Worker (LHW)-facilitated community engagement and early diagnosis, stabilization and referral of women with preeclampsia, an important contributor to adverse maternal and perinatal outcomes given delays in early detection and initial management.<h4>Study design</h4>In the Pakistan Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomized controlled trial (NCT01911494), ...[more]