Community resource centres to improve the health of women and children in informal settlements in Mumbai: a cluster-randomised, controlled trial

Shah More, Neena and Das, Sushmita and Bapat, Ujwala and Alcock, Glyn and Manjrekar, Shreya and Kamble, Vikas and Sawant, Rijuta and Shende, Sushma and Daruwalla, Nayreen and Pantvaidya, Shanti and Osrin, David (2017) Community resource centres to improve the health of women and children in informal settlements in Mumbai: a cluster-randomised, controlled trial. The Lancet Global Health, 5 (3). e335-e349. ISSN 0140-6736


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Background Around 105 million people in India will be living in informal settlements by 2017. We investigated the eff ects of local resource centres delivering integrated activities to improve women’s and children’s health in urban informal settlements. Methods In a cluster-randomised controlled trial in 40 clusters, each containing around 600 households, 20 were random ly allocated to have a resource centre (intervention group) and 20 no centre (control group). Community organisers in the intervention centres addressed maternal and neonatal health, child health and nutrition, reproductive health, and prevention of violence against women and children through home visits, group meetings, day care, community events, service provision, and liaison. The primary endpoints were met need for family planning in women aged 15–49 years, proportion of children aged 12–23 months fully immunised, and proportion of children younger than 5 years with anthropometric wasting. Census interviews with women aged 15–49 years were done before and 2 years after the intervention was implemented. The primary intention-to-treat analysis compared cluster allocation groups after the intervention. We also analysed the per-protocol population (all women with data from both censuses) and assessed cluster-level changes. This study is registered with ISRCTN, number ISRCTN56183183, and Clinical Trials Registry of India, number CTRI/2012/09/003004. Findings 12 614 households were allocated to the intervention and 12 239 to control. Postintervention data were available for 8271 women and 5371 children younger than 5 years in the intervention group, and 7965 women and 5180 children in the control group. Met need for family planning was greater in the intervention clusters than in the control clusters (odds ratio [OR] 1·31, 95% CI 1·11–1·53). The proportions of fully immunised children were similar in the intervention and control groups in the intention-to-treat analysis (OR 1·30, 95% CI 0·84–2·01), but were greater in the intervention group when assessed per protocol (1·73, 1·05–2·86). Childhood wasting did not diff er between groups (OR 0·92, 95% CI 0·75–1·12), although improvement was seen at the cluster level in the intervention group (p=0·020). Interpretation This community resource model seems feasible and replicable and may be protocolised for expansion.

Item Type: Article
Subjects: WA Public Health
Divisions: Faculty of Medicin
Depositing User: Touba Derakhshande
Date Deposited: 12 Sep 2017 07:14
Last Modified: 12 Sep 2017 07:14

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