Community action for newborn care and survival through participatory women's groups and health workers in rural Bangladesh: a before-and-after implementation study of scale-up.

BackgroundCommunity mobilisation through participatory womens groups (PWGs) has been shown to be an effective intervention to improve maternal and neonatal survival in low-income settings, including Bangladesh. Despite WHO recommendations and scale-up in some contexts, the intervention has not been widely scaled-up in Bangladesh. To add to the existing evidence-base for PWGs and to renew calls for effective, scalable interventions to improve neonatal outcomes in the post-Sustainable Development Goals era, we report the design, implementation and evaluation of a volunteer-led model for PWGs delivered in rural Bangladesh in 2014/15. MethodsWorking in three rural unions in Faridpur, Bangladesh, we applied a volunteer-led, lower coverage and shorter duration PWG intervention. Mixed methods evaluation monitored key indicators of intervention delivery, uptake and receipt. Prospective quantitative surveys gathered data on birth outcomes, health care utilisation and essential newborn care practices. Data from before and after the implementation period were compared and interpreted in relation to historical trends in the study area and other rural areas of Bangladesh. Results180 participatory womens groups facilitated by 45 volunteer facilitators over a period of 15 months were successfully implemented giving a population coverage of one group per 500 population. An average of 32 (min.=18, max.=64) participants attended each PWG meeting, 42% of participants attended meetings on a monthly basis and 11% reported that they actively shared information from the PWGs with non-attenders. 30% of women of reproductive age and 54% of pregnant women participated in the. Focus group discussions with participants and community members revealed positive attitudes towards the groups. A change in trend in extended perinatal mortality rates was observed during the intervention period, corresponding temporally with indicators of improved rates of service utilisation and essential newborn care practices relative to the pre-implementation period. ConclusionThe modified PWG intervention likely contributed to positive changes in delivery and neonatal care practices similar to previous studies in Bangladesh. The PWG model remains an important approach to community empowerment that could contribute to enhanced efforts to end preventable neonatal deaths as we move towards the end of the Sustainable Development Goal era and beyond.