• Maternal, newborn and child health

Maternal, newborn and child health

Of the 4 million neonatal deaths worldwide every year, most occur in developing countries. In Nepal, the burden of neonatal mortality is especially high, and over 90 percent of births take place at home without a trained attendant. Because of geographic and financial realities, achieving a substantial increase in facility-based deliveries is unlikely to be feasible in the short-term. Interventions promoting changes in practices at home and in the community might therefore be more realistic, locally relevant, and cost effective. This article in The Lancet examines a cost-effectiveness analysis alongside a cluster-randomised controlled trial of a participatory intervention with women's groups aiming to improve birth outcomes in rural Nepal.

The authors assessed the effect of facilitators working with women's groups to develop strategies for improvement of maternal and neonatal health. The article outlines the intervention's effectiveness, achieving a 29 percent reduction in neonatal mortality and a substantial reduction in maternal mortality during 33 months. It is highlighted that in view of resource scarcity, the question remains over whether this intervention represents good value for money. Therefore a cost-effectiveness analysis was carried out comparing the women's group intervention with current practice. We also examined resource requirements for programme expansion. The authors find that the average provider cost of the women's group intervention was US$0•75 per person per year in a population of 86,704. The incremental cost per life-year saved (LYS) was $211 and expansion could rationalise on start-up costs and technical assistance, reducing the cost per LYS to $138. The paper finds that this intervention could provide a cost-effective way of reducing neonatal deaths.

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