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Fottrell, Edward F
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Publications (10 of 35) Show all publications
Byass, P., Herbst, K., Fottrell, E., Ali, M. M., Odhiambo, F., Amek, N., . . . Tollman, S. M. (2015). Comparing verbal autopsy cause of death findings as determined by physician coding and probabilistic modelling: a public health analysis of 54 000 deaths in Africa and Asia. Journal of Global Health, 5(1), 65-73, Article ID 010402.
Open this publication in new window or tab >>Comparing verbal autopsy cause of death findings as determined by physician coding and probabilistic modelling: a public health analysis of 54 000 deaths in Africa and Asia
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2015 (English)In: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 5, no 1, 65-73 p., 010402Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Coverage of civil registration and vital statistics varies globally, with most deaths in Africa and Asia remaining either unregistered or registered without cause of death. One important constraint has been a lack of fit-for-purpose tools for registering deaths and assigning causes in situations where no doctor is involved. Verbal autopsy (interviewing care-givers and witnesses to deaths and interpreting their information into causes of death) is the only available solution. Automated interpretation of verbal autopsy data into cause of death information is essential for rapid, consistent and affordable processing.

METHODS: Verbal autopsy archives covering 54 182 deaths from five African and Asian countries were sourced on the basis of their geographical, epidemiological and methodological diversity, with existing physician-coded causes of death attributed. These data were unified into the WHO 2012 verbal autopsy standard format, and processed using the InterVA-4 model. Cause-specific mortality fractions from InterVA-4 and physician codes were calculated for each of 60 WHO 2012 cause categories, by age group, sex and source. Results from the two approaches were assessed for concordance and ratios of fractions by cause category. As an alternative metric, the Wilcoxon matched-pairs signed ranks test with two one-sided tests for stochastic equivalence was used.

FINDINGS: The overall concordance correlation coefficient between InterVA-4 and physician codes was 0.83 (95% CI 0.75 to 0.91) and this increased to 0.97 (95% CI 0.96 to 0.99) when HIV/AIDS and pulmonary TB deaths were combined into a single category. Over half (53%) of the cause category ratios between InterVA-4 and physician codes by source were not significantly different from unity at the 99% level, increasing to 62% by age group. Wilcoxon tests for stochastic equivalence also demonstrated equivalence.

CONCLUSIONS: These findings show strong concordance between InterVA-4 and physician-coded findings over this large and diverse data set. Although these analyses cannot prove that either approach constitutes absolute truth, there was high public health equivalence between the findings. Given the urgent need for adequate cause of death data from settings where deaths currently pass unregistered, and since the WHO 2012 verbal autopsy standard and InterVA-4 tools represent relatively simple, cheap and available methods for determining cause of death on a large scale, they should be used as current tools of choice to fill gaps in cause of death data.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-110451 (URN)10.7189/jogh.05.010402 (DOI)000370619100007 ()25734004 (PubMedID)
Available from: 2015-10-21 Created: 2015-10-21 Last updated: 2017-12-01Bibliographically approved
Hussain-Alkhateeb, L., Fottrell, E., Petzold, M., Kahn, K. & Byass, P. (2015). Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death. Global Health Action, 8, 1-9, Article ID 28302.
Open this publication in new window or tab >>Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death
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2015 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 8, 1-9 p., 28302Article in journal (Refereed) Published
Abstract [en]

Background: Understanding how lay people perceive the causes of mortality and their associated risk factors is important for public health. In resource-limited settings, where verbal autopsy (VA) is used as the most expedient method of determining cause of death, it is important to understand how pre-existing concepts of cause of death among VA-informants may influence their VA-responses and the consequential impact on cause of death assessment. This study describes the agreement between VA-derived causes of death and informant-perceived causes and associated influential factors, which also reflects lay health literacy in this setting. Method: Using 20 years of VA data (n = 11,228) from the Agincourt Health and Demographic Surveillance System (HDSS) site in rural South Africa, we explored the agreement between the causes of death perceived by the VA-informants and those assigned by the automated Inter-VA tool. Kappa statistics and concordance correlation coefficients were applied to measure agreement at individual and population levels, respectively. Multivariable regression models were used to explore factors associated with recognised lay perceptions of causes of mortality. Results: Agreement between informant-perceived and VA-derived causes of death at the individual level was limited, but varied substantially by cause of death. However, agreement at the population level, comparing cause-specific mortality fractions was higher, with the notable exception of bewitchment as a cause. More recent deaths, those in adults aged 15-49 years, deaths outside the home, and those associated with external causes showed higher concordance with InterVA. Conclusion: Overall, informant perception of causes of death was limited, but depended on informant characteristics and causes of death, and to some extent involved non-biomedical constructs. Understanding discordance between perceived and recognised causes of death is important for public health planning; low community understanding of causes of death may be detrimental to public health. These findings also illustrate the importance of using rigorous and standardised VA methods rather than relying on informants' reported causes of death.

Keyword
community perception, causes of death, verbal autopsy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-107183 (URN)10.3402/gha.v8.28302 (DOI)000358180600001 ()26193897 (PubMedID)
Available from: 2015-09-01 Created: 2015-08-19 Last updated: 2017-12-04Bibliographically approved
Fottrell, E., Högberg, U., Ronsmans, C., Osrin, D., Azad, K., Nair, N., . . . Filippi, V. (2014). A probabilistic method to estimate the burden of maternal morbidity in resource-poor settings: preliminary development and evaluation. Emerging Themes in Epidemiology, 11(1), 3.
Open this publication in new window or tab >>A probabilistic method to estimate the burden of maternal morbidity in resource-poor settings: preliminary development and evaluation
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2014 (English)In: Emerging Themes in Epidemiology, ISSN 1742-7622, E-ISSN 1742-7622, Vol. 11, no 1, 3- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Maternal morbidity is more common than maternal death, and population-based estimates of the burden of maternal morbidity could provide important indicators for monitoring trends, priority setting and evaluating the health impact of interventions. Methods based on lay reporting of obstetric events have been shown to lack specificity and there is a need for new approaches to measure the population burden of maternal morbidity. A computer-based probabilistic tool was developed to estimate the likelihood of maternal morbidity and its causes based on self-reported symptoms and pregnancy/delivery experiences. Development involved the use of training datasets of signs, symptoms and causes of morbidity from 1734 facility-based deliveries in Benin and Burkina Faso, as well as expert review. Preliminary evaluation of the method compared the burden of maternal morbidity and specific causes from the probabilistic tool with clinical classifications of 489 recently-delivered women from Benin, Bangladesh and India.

RESULTS: Using training datasets, it was possible to create a probabilistic tool that handled uncertainty of women's self reports of pregnancy and delivery experiences in a unique way to estimate population-level burdens of maternal morbidity and specific causes that compared well with clinical classifications of the same data. When applied to test datasets, the method overestimated the burden of morbidity compared with clinical review, although possible conceptual and methodological reasons for this were identified.

CONCLUSION: The probabilistic method shows promise and may offer opportunities for standardised measurement of maternal morbidity that allows for the uncertainty of women's self-reported symptoms in retrospective interviews. However, important discrepancies with clinical classifications were observed and the method requires further development, refinement and evaluation in a range of settings.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
Maternal health, Morbidity, Developing countries, Pregnancy, Childbirth, Bayesian analysis, Africa, Asia
National Category
Public Health, Global Health, Social Medicine and Epidemiology Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:umu:diva-90534 (URN)10.1186/1742-7622-11-3 (DOI)24620784 (PubMedID)
Available from: 2014-06-24 Created: 2014-06-24 Last updated: 2017-12-05Bibliographically approved
Hall, C. S., Fottrell, E., Wilkinson, S. & Byass, P. (2014). Assessing the impact of mHealth interventions in low- and middle-income countries: what has been shown to work?. Global Health Action, 7, 1-12, Article ID 25606.
Open this publication in new window or tab >>Assessing the impact of mHealth interventions in low- and middle-income countries: what has been shown to work?
2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, 1-12 p., 25606Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Low-cost mobile devices, such as mobile phones, tablets, and personal digital assistants, which can access voice and data services, have revolutionised access to information and communication technology worldwide. These devices have a major impact on many aspects of people's lives, from business and education to health. This paper reviews the current evidence on the specific impacts of mobile technologies on tangible health outcomes (mHealth) in low- and middle-income countries (LMICs), from the perspectives of various stakeholders.

DESIGN: Comprehensive literature searches were undertaken using key medical subject heading search terms on PubMed, Google Scholar, and grey literature sources. Analysis of 676 publications retrieved from the search was undertaken based on key inclusion criteria, resulting in a set of 76 papers for detailed review. The impacts of mHealth interventions reported in these papers were categorised into common mHealth applications.

RESULTS: There is a growing evidence base for the efficacy of mHealth interventions in LMICs, particularly in improving treatment adherence, appointment compliance, data gathering, and developing support networks for health workers. However, the quantity and quality of the evidence is still limited in many respects.

CONCLUSIONS: Over all application areas, there remains a need to take small pilot studies to full scale, enabling more rigorous experimental and quasi-experimental studies to be undertaken in order to strengthen the evidence base.

Place, publisher, year, edition, pages
Rockville Pike, Bethesda MD, USA: National Center for Biotechnology Information,U.S. National Library of Medicine, 2014
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-95820 (URN)10.3402/gha.v7.25606 (DOI)000344630100001 ()25361730 (PubMedID)
Available from: 2014-11-05 Created: 2014-11-05 Last updated: 2017-12-05Bibliographically approved
Santosa, A., Wall, S., Fottrell, E., Högberg, U. & Byass, P. (2014). The development and experience of epidemiological transition theory over four decades: a systematic review. Global Health Action, 7, Article ID 23574.
Open this publication in new window or tab >>The development and experience of epidemiological transition theory over four decades: a systematic review
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2014 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 7, 23574Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Epidemiological transition (ET) theory, first postulated in 1971, has developed alongside changes in population structures over time. However, understandings of mortality transitions and associated epidemiological changes remain poorly defined for public health practitioners. Here, we review the concept and development of ET theory, contextualising this in empirical evidence, which variously supports and contradicts the original theoretical propositions.

DESIGN: A Medline literature search covering publications over four decades, from 1971 to 2013, was conducted. Studies were included if they assessed human populations, were original articles, focused on mortality and health or demographic or ET and were in English. The reference lists of the selected articles were checked for additional sources.

RESULTS: We found that there were changes in emphasis in the research field over the four decades. There was an increasing tendency to study wide-ranging aspects of the determinants of mortality, including risk factors, lifestyle changes, socio-economics, and macro factors such as climate change. Research on ET has focused increasingly on low- and middle-income countries rather than industrialised countries, despite its origins in industrialised countries. Countries have experienced different levels of progress in ET in terms of time, pace, and underlying mechanisms. Elements of ET are described for many countries, but observed transitions have not always followed pathways described in the original theory.

CONCLUSIONS: The classic ET theory largely neglected the critical role of social determinants, being largely a theoretical generalisation of mortality experience in some countries. This review shows increasing interest in ET all over the world but only partial concordance between established theory and empirical evidence. Empirical evidence suggests that some unconsidered aspects of social determinants contributed to deviations from classic theoretical pathways. A better-constructed, revised ET theory, with a stronger basis in evidence, is needed.

Place, publisher, year, edition, pages
CoAction Publishing, 2014
Keyword
epidemiological transition, demographic transition, mortality, social determinants
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-90531 (URN)10.3402/gha.v7.23574 (DOI)000336456100003 ()24848657 (PubMedID)
Note

Special Issue: Epidemiological Transitions – Beyond Omran’s Theory

Available from: 2014-06-24 Created: 2014-06-24 Last updated: 2017-12-05Bibliographically approved
Bird, J., Byass, P., Kahn, K., Mee, P. & Fottrell, E. (2013). A matter of life and death: practical and ethical constraints in the development of a mobile verbal autopsy tool. In: CHI '13 Proceedings of the SIGCHI Conference on Human Factors in Computing SystemsPages 1489-1498: . Paper presented at 31st Annual CHI Conference on Human Factors in Computing Systems: Changing Perspectives, CHI 2013, 27 April 2013 through 2 May 2013, Paris (pp. 1489-1498). .
Open this publication in new window or tab >>A matter of life and death: practical and ethical constraints in the development of a mobile verbal autopsy tool
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2013 (English)In: CHI '13 Proceedings of the SIGCHI Conference on Human Factors in Computing SystemsPages 1489-1498, 2013, 1489-1498 p.Conference paper, Published paper (Refereed)
Abstract [en]

Verbal autopsy (VA) involves interviewing relatives of the deceased to identify the probable cause of death and is typically used in settings where there is no official system for recording deaths or their causes. Following the interview, physician assessment to determine probable cause can take several years to complete. The World Health Organization (WHO) recognizes that there is a pressing need for a mobile device that combines direct data capture and analysis if this technique is to become part of routine health surveillance. We conducted a field test in rural South Africa to evaluate a mobile system that we designed to meet WHO requirements (namely, simplicity, feasibility, adaptability to local contexts, cost-effectiveness and program relevance). If desired, this system can provide immediate feedback to respondents about the probable cause of death at the end of a VA interview. We assessed the ethical implications of this technological development by interviewing all the stakeholders in the VA process (respondents, fieldworkers, physicians, population scientists, data managers and community engagement managers) and highlight the issues that this community needs to debate and resolve.

Series
Conference on Human Factors in Computing Systems - Proceedings
Keyword
Ethics, HCI4D, Mobile devices, Verbal autopsy
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-83229 (URN)10.1145/2470654.2466198 (DOI)978-1-4503-1899-0 (ISBN)
Conference
31st Annual CHI Conference on Human Factors in Computing Systems: Changing Perspectives, CHI 2013, 27 April 2013 through 2 May 2013, Paris
Available from: 2013-11-22 Created: 2013-11-21 Last updated: 2015-04-29Bibliographically approved
Leitao, J., Chandramohan, D., Byass, P., Jakob, R., Bundhamcharoen, K., Choprapawon, C., . . . Mathai, M. (2013). Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring. Global Health Action, 6, 21518.
Open this publication in new window or tab >>Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring
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2013 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, 21518- p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems.

METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification.

FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach.

CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians.

Place, publisher, year, edition, pages
CoAction Publishing, 2013
Keyword
verbal autopsy, cause of death, vital registration, civil registration, vital statistics, World Health Organization, Inter VA
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-86011 (URN)10.3402/gha.v6i0.21518 (DOI)000324293600001 ()24041439 (PubMedID)
Available from: 2014-02-14 Created: 2014-02-14 Last updated: 2017-12-06Bibliographically approved
Fottrell, E. & Osrin, D. (2013). Sickle Cell Anaemia in a Changing World. PLoS Medicine, 10(7), e1001483.
Open this publication in new window or tab >>Sickle Cell Anaemia in a Changing World
2013 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 10, no 7, e1001483- p.Article in journal, Editorial material (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-79911 (URN)10.1371/journal.pmed.1001483 (DOI)000322590800009 ()
Available from: 2013-09-09 Created: 2013-09-04 Last updated: 2017-12-06Bibliographically approved
Fottrell, E., Azad, K., Kuddus, A., Younes, L., Shaha, S., Nahar, T., . . . Houweling, T. A. (2013). The effect of increased coverage of participatory women's groups on neonatal mortality in Bangladesh: A cluster randomized trial. JAMA pediatrics, 167(9), 816-25.
Open this publication in new window or tab >>The effect of increased coverage of participatory women's groups on neonatal mortality in Bangladesh: A cluster randomized trial
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2013 (English)In: JAMA pediatrics, ISSN 2168-6211, Vol. 167, no 9, 816-25 p.Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE: Community-based interventions can reduce neonatal mortality when health systems are weak. Population coverage of target groups may be an important determinant of their effect on behavior and mortality. A women's group trial at coverage of 1 group per 1414 population in rural Bangladesh showed no effect on neonatal mortality, despite a similar intervention having a significant effect on neonatal and maternal death in comparable settings.

OBJECTIVE: To assess the effect of a participatory women's group intervention with higher population coverage on neonatal mortality in Bangladesh.

DESIGN: A cluster randomized controlled trial in 9 intervention and 9 control clusters.

SETTING: Rural Bangladesh.

PARTICIPANTS: Women permanently residing in 18 unions in 3 districts and accounting for 19 301 births during the final 24 months of the intervention.

INTERVENTIONS: Women's groups at a coverage of 1 per 309 population that proceed through a participatory learning and action cycle in which they prioritize issues that affected maternal and neonatal health and design and implement strategies to address these issues.

MAIN OUTCOMES AND MEASURES: Neonatal mortality rate.

RESULTS: Analysis included 19 301 births during the final 24 months of the intervention. More than one-third of newly pregnant women joined the groups. The neonatal mortality rate was significantly lower in the intervention arm (21.3 neonatal deaths per 1000 live births vs 30.1 per 1000 in control areas), a reduction in neonatal mortality of 38% (risk ratio, 0.62 [95% CI, 0.43-0.89]) when adjusted for socioeconomic factors. The cost-effectiveness was US $220 to $393 per year of life lost averted. Cause-specific mortality rates suggest reduced deaths due to infections and those associated with prematurity/low birth weight. Improvements were seen in hygienic home delivery practices, newborn thermal care, and breastfeeding practices.

CONCLUSIONS AND RELEVANCE: Women's group community mobilization, delivered at adequate population coverage, is a highly cost-effective approach to improve newborn survival and health behavior indicators in rural Bangladesh.

TRIAL REGISTRATION: isrctn.org Identifier: ISRCTN01805825.

Place, publisher, year, edition, pages
American Medical Association, 2013
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-82844 (URN)10.1001/jamapediatrics.2013.2534 (DOI)23689475 (PubMedID)
Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2016-02-15Bibliographically approved
Prost, A., Colbourn, T., Seward, N., Azad, K., Coomarasamy, A., Copas, A., . . . Costello, A. (2013). Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. The Lancet, 381(9879), 1736-46.
Open this publication in new window or tab >>Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis
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2013 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 381, no 9879, 1736-46 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Maternal and neonatal mortality rates remain high in many low-income and middle-income countries. Different approaches for the improvement of birth outcomes have been used in community-based interventions, with heterogeneous effects on survival. We assessed the effects of women's groups practising participatory learning and action, compared with usual care, on birth outcomes in low-resource settings.

METHODS: We did a systematic review and meta-analysis of randomised controlled trials undertaken in Bangladesh, India, Malawi, and Nepal in which the effects of women's groups practising participatory learning and action were assessed to identify population-level predictors of effect on maternal mortality, neonatal mortality, and stillbirths. We also reviewed the cost-effectiveness of the women's group intervention and estimated its potential effect at scale in Countdown countries.

FINDINGS: Seven trials (119,428 births) met the inclusion criteria. Meta-analyses of all trials showed that exposure to women's groups was associated with a 37% reduction in maternal mortality (odds ratio 0.63, 95% CI 0.32-0.94), a 23% reduction in neonatal mortality (0.77, 0.65-0.90), and a 9% non-significant reduction in stillbirths (0.91, 0.79-1.03), with high heterogeneity for maternal (I(2)=58.8%, p=0.024) and neonatal results (I(2)=64.7%, p=0.009). In the meta-regression analyses, the proportion of pregnant women in groups was linearly associated with reduction in both maternal and neonatal mortality (p=0.026 and p=0.011, respectively). A subgroup analysis of the four studies in which at least 30% of pregnant women participated in groups showed a 55% reduction in maternal mortality (0.45, 0.17-0.73) and a 33% reduction in neonatal mortality (0.67, 0.59-0.74). The intervention was cost effective by WHO standards and could save an estimated 283,000 newborn infants and 41,100 mothers per year if implemented in rural areas of 74 Countdown countries.

INTERPRETATION: With the participation of at least a third of pregnant women and adequate population coverage, women's groups practising participatory learning and action are a cost-effective strategy to improve maternal and neonatal survival in low-resource settings.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-82845 (URN)10.1016/S0140-6736(13)60685-6 (DOI)23683640 (PubMedID)
Funder
Wellcome trust
Note

FUNDING: Wellcome Trust, Ammalife, and National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Birmingham and the Black Country programme.

Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2017-12-06Bibliographically approved
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