Open Access Open Badges Study protocol

Improved accessibility of emergency obstetrics and newborn care(EmONC) services for maternal and newborn health: a community based project

Ali Turab1, Shabina Ariff1, Muhammad A Habib1, Imran Ahmed1, Masawar Hussain1, Akhtar Rashid2, Zahid Memon3, Mohammad I Khan4, Sajid Soofi1 and Zulfiqar A Bhutta56*

Author Affiliations

1 Department of Paediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan

2 Provincial Programme for Family planning and Primary health care (Lady Health workers programme) for Punjab, Lahore, Pakistan

3 Maternal and Newborn Health Programme, Research and Advocacy Fund, Islamabad, Pakistan

4 International Vaccine Institute, Seoul, Korea

5 Founding Director Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan

6 Co-Director, Center for Global Child Health, Hospital for Sick Children, Toronto, Canada

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BMC Pregnancy and Childbirth 2013, 13:136  doi:10.1186/1471-2393-13-136

Published: 24 June 2013



Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur.


This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization.


Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes.

The findings of this proposed community based trial will provide sufficient evidence on feasibility, acceptability and effectiveness to the policy makers for replicating and scaling up the interventions within the health system

Trial registration NCT01751945

Emergency Obstetrics and Newborn Care (EmONC); Perinatal mortality; Neonatal mortality; Reproductive health; Child health; Pakistan