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The unit of randomization, treatment, and analysis was the village and village development committee (VDC) in a rural mountainous area, Makwanpur district, of Nepal. All 42 VDCs in the district were eligible for randomization: one was excluded due to security reasons. Of the 42 pair-matched VDCs, 12 village pairs were randomly selected: 12 experimental and 12 control villages. The study population included all married women of reproductive age (15-49 years) who had the potential to become pregnant and provided consent. Eligible villages were pair-matched on topography, ethnicity, and population density. The average village cluster was ~7,000 people. One VDC in each pair was randomly assigned to an E or C group. Systematic surveillance of all pregnancies and related outcomes was implemented for 2.5 years. Data on 28,931 women and all pregnancy-related events were regularly collected.


A local facilitator conducted nine women’s group meetings in all nine wards every month. One supervisor for three facilitators attended the meetings and assisted in implementation. The intervention consisted of a series of 10 meetings, one per month, for one year. Through basic health education and participatory learning techniques, women discussed the purposes of the study and the intervention, learned how to identify maternal and neonatal problems and strategies to identify and share more information in the community, and how to prioritize mother and child health problems. They discussed possible practical solutions to address their problems and how to involve other community members. Strategies within the communities included community-generated funds for maternal and infant care, stretcher and transportation plans, and production and distribution of clean delivery kits. A film and card game created locally were developed and delivered as part of the health education program to improve infant and maternal health.

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