Effects of quality improvement in health facilities and community mobilization through women's groups on maternal, neonatal and perinatal mortality in three districts of Malawi: MaiKhanda, a cluster randomized controlled effectiveness trial.

BACKGROUND: Maternal, perinatal and neonatal mortality remains high in low-income countries. We evaluated community and facility-based interventions to reduce deaths in three districts of Malawi. METHODS: We evaluated a rural participatory women's group community intervention (CI) and a quality improvement intervention at health centres (FI) via a two-by-two factorial cluster randomized controlled trial. Consenting pregnant women were followed-up to 2 months after birth using key informants. Primary outcomes were maternal, perinatal and neonatal mortality. Clusters were health centre catchment areas assigned using stratified computer-generated randomization. Following exclusions, including non-birthing facilities, 61 clusters were analysed: control (17 clusters, 4912 births), FI (15, 5335), CI (15, 5080) and FI + CI (14, 5249). This trial was registered as International Standard Randomised Controlled Trial [ISRCTN18073903]. Outcomes for 14,576 and 20,576 births were recorded during baseline (June 2007-September 2008) and intervention (October 2008-December 2010) periods. RESULTS: For control, FI, CI and FI + CI clusters neonatal mortality rates were 34.0, 28.3, 29.9 and 27.0 neonatal deaths per 1000 live births and perinatal mortality rates were 56.2, 55.1, 48.0 and 48.4 per 1000 births, during the intervention period. Adjusting for clustering and stratification, the neonatal mortality rate was 22% lower in FI + CI than control clusters (OR = 0.78, 95% CI 0.60-1.01), and the perinatal mortality rate was 16% lower in CI clusters (OR = 0.84, 95% CI 0.72-0.97). We did not observe any intervention effects on maternal mortality. CONCLUSIONS: Despite implementation problems, a combined community and facility approach using participatory women's groups and quality improvement at health centres reduced newborn mortality in rural Malawi.

Living same-name siblings and British historical demography.

This article examines the extent to which living siblings were given identical first names. Whilst the practice of sibling name-sharing appeared to have died out in England during the eighteenth century, in northern Scotland it persisted at least until the end of the nineteenth century. Previously it has not been possible to provide quantitative evidence of this phenomenon, but an analysis of the rich census and vital registration data for the Isle of Skye reveals that this practice was widespread, with over a third of eligible families recording same-name siblings. Our results suggest that further research should focus on regional variations in sibling name-sharing and the extent to which this northern pattern occurred in other parts of Britain.

Intellectual disability in homeless adults: a prevalence study.

There has been considerable recent interest in the health and associated socio-economic inequalities faced by adults with learning disabilities. A serious and so far under-reported aspect of this is homelessness. This study sought to determine the prevalence of intellectual disability in a homeless population. Fifty people registered at a general practice in north-east England for socially excluded groups, and staying in temporary accommodation for the homeless during 2006-7, were assessed for learning disability. Full-scale and verbal IQ scores for the group were significantly lower than would be expected in the general population, but there was no significant difference in performance IQ. Homeless people are significantly more likely to have an intellectual disability than the general population. The implications for practice and policy development are far reaching. Further work is required to confirm these findings and to explore the experience of homeless people with intellectual disability.

Three patients with migraine following caloric-induced vestibular stimulation.

The co-occurrence of migraine and dizziness is greater than would be expected by chance. We report 3 patients who developed migraine following acute vertigo precipitated during caloric testing. A small proportion of the epidemiological links between migraine and vertigo may be due to vertigo-triggered migraine.