Community-level interventions for pre-eclampsia (CLIP) in Pakistan: A cluster randomised controlled trial

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Global Health

Background:

• Preeclampsia is a major contributor to adverse maternal and perinatal outcomes.
• Delays in early detection and management of preeclampsia exacerbate risks.
• Community engagement and early intervention are crucial for improving maternal and newborn health.

Purpose of the Study:

• To reduce all-cause maternal and perinatal mortality and major morbidity.
• To assess the impact of Lady Health Worker (LHW)-facilitated community engagement and early preeclampsia management.
• To evaluate the effectiveness of the Pakistan Community-Level Interventions for Pre-eclampsia (CLIP) trial.

Main Methods:

• A cluster randomized controlled trial involving 39,446 pregnant women across 20 union councils in Pakistan.
• Lady Health Workers (LHWs) facilitated community engagement, mobile health-guided clinical assessment for preeclampsia, and referral after stabilization.
• The primary outcome was a composite of maternal, fetal, and newborn mortality and major morbidity.

Main Results:

• The primary composite outcome did not differ significantly between intervention and control clusters (26.6% vs. 21.9%).
• A significant reduction in stillbirths was observed (aOR 0.89; p=0.03), but no impact on maternal death or morbidity.
• Improvements in outcome rates correlated with increased CLIP contacts, with significant benefits seen with 4-7 and ≥8 contacts.

Conclusions:

• The CLIP intervention was well-accepted and implemented by LHWs.
• Lack of overall effect on adverse outcomes may be linked to the quality of care provided in health facilities.
• Future community outreach strategies must be integrated with health facility strengthening to improve maternal and perinatal outcomes.