Impact of a community-based intervention package delivered through community health workers on post-partum care practices: a cluster randomized controlled trial

Aim: This study assesses the impact of a community-based intervention package delivered through community lady health workers (LHWs) to improve early postpartum and newborn care practices. Methods: A cluster randomized controlled trial was carried out in Sukkur, Sindh Province, Pakistan. We conducted a baseline survey and delivered an enhanced postpartum care package through the existing LHW cadre to the intervention clusters. Results: Thirty clusters were randomly assigned to the intervention and control groups. A total of 3999 women in the intervention group and 3234 women in the control group were enrolled. During the study period, there were 1296 births in the intervention arm and 1326 in the control arm. Compared with the control group, the intervention group showed a significant improvement in the number of women receiving antenatal care (p = 0.001), fewer home deliveries (p = 0.022), increased number of deliveries by skilled birth attendants (p = 0.005), and more participation in care-seeking practices during the postpartum period (p = 0.023). Similarly, hygienic cord-cutting (p = 0.014) and a cord clamp (p = 0.049) were prevalent in the intervention group. Moreover, the intervention group had more visits by LHWs during pregnancy and in the postpartum period. Conclusion: The use of maternal and neonatal intervention packages through trained community LHWs within the existing health system has the potential to improve maternal, perinatal and neonatal care practices, particularly in low-resource settings where home deliveries still occur.