A cluster randomised controlled trial of reorganising maternal health care services in Sindh, Pakistan.
A community-based randomised controlled trial was conducted in the district Larkana
of Sindh province of Pakistan. The new model was based on reorganising the existing
maternal health services.
Three sub-districts were randomly assigned to the intervention group and four to the
control group. The intervention consisted of integrating traditional birth attendants with
the health care system, the use of safe delivery packs and the provision of antenatal care
Over one year 19,525 women were recruited and followed up. The proportion of
referrals was higher in the intervention group (10.0 Vs 6.9 %; odds ratio 1.50 [95% Cl
1.26-1.74]). Significant differences were also found in some pregnancy complications
including haemorrhage, obstructed labour and puerperal sepsis. Perinatal mortality in
the intervention group was 83, compared to 118 per 1000 births for the control group,
odds ratio 0.69 (95% Cl 0.53-0.85)(P