Maternal and Infant Mortality Rates Reduced by Peer Support

Tinker Ready

May 20, 2013

Two studies on the effect of peer support on maternal and infant mortality have broken new ground by using randomized controlled trials, according to an accompanying comment, which appear in the May 18 issue of the Lancet.

Those who endorse the "somewhat ethereal ideas such as empowerment," are not usually enthusiastic about doing such trials, write Cesar G. Victoria, MD, from the Universidad Federal de Pelotas in Pelotas, Brazil, and Fernando C. Barros, MD, from the Catholic University of Pelotas, Pelotas, Brazil, in an accompanying comment.

"The greatest accomplishment of this group of investigators is to combine both," they note, describing the studies as "a breath of fresh air" for maternal and child health research.

Both studies, one a meta-analysis of randomized trials and the other a randomized trial in rural Malawi, looked at women and children in low- to middle-income communities.

In the first study, Audrey Prost, PhD, from the Institute for Global Health, University College in London, United Kingdom, and colleagues, conducted a meta-analysis of 7 randomized controlled trials of women's groups in Malawi, India, Bangladesh, and Nepal.

They note that in 2011, despite improvements in maternal and infant mortality, an estimated 273,465 mothers died from complications of pregnancy and childbirth, and 2.9 million infants died within the first month of life.

The authors found that women's support groups engaged in participatory learning and action were associated with a 37% reduction in maternal mortality (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.32 - 0.94) and a 23% reduction in neonatal mortality (OR, 0.77; 95% CI, 0.65 - 0.90). Their approach, which was found to be "cost effective by WHO standards," could save an estimated 283,000 newborn infants and 41,100 mothers per year, the researchers conclude.

The second study, performed by Sonia Lewycka, PhD, also from the Institute for Global Health, and colleagues looked at the effect of both women's groups and volunteer peer counselling on mortality and morbidity in mothers and children in rural Malawi. The researchers enrolled 185,888 women and assigned them to groups offering varying levels of support. The interventions included a facilitated maternal and child health group and home visits from volunteer peer counselors. They collected data on 26,262 births between 2005 and 2009.

The researchers estimated that women's group intervention reduced maternal death by 74% (OR, 0.26; 95% CI, 0.10 - 0.70), neonatal mortality rate by 41% (OR, .59; 95% CI, 0.40 - 0.86), and infant mortality by 28% (OR, 0.72; 95% CI, 0.56 - 0.94) in the second and third years of the study. The use of peer counselors reduced infant mortality by 36% (OR, 0.64; 95% CI, 0.48 - 0.85) during the 3-year study.

In their commentary, Dr. Victoria and Dr. Barros write that the evidence in the 2 studies is so strong that the approach should be scaled up, but "accompanied by rigorous evaluation," combining quantitative and qualitative methods. The follow-up would also offer data on the efficacy of participation efforts and the mechanisms behind the intervention effects.

"This approach would provide rigorous evidence about how participatory interventions, when scaled up, will deliver what they promise," they write.

Dr. Victoria and Dr. Barros have disclosed no relevant financial relationships. All but 4 authors of the Prose analysis have been involved in some of the studies included in the review. The research was funded but Wellcome Trust, Ammalife, and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Birmingham and the Black Country program. The authors of the Malawi study have disclosed no relevant financial relationships. Primary funding came from Saving Newborn Lives with later contributions from the UK Department for International Development, Wellcome Trust, Institute of Child Health, and UNICEF Malawi.

Lancet. 2013;381:1693-1694, 1721-1746. Prost abstract, Lewycka abstract, Comment extract

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