Please select the eligibility criteria that correspond to the clinical trial below.
Title: Community-based Perinatal and Newborn Care in Gilgit District, Northern Areas, Pakistan: an AKU-AKHSP Collaboration
Brief Summary: There is limited evidence from community-based interventions to guide the development of effective maternal, perinatal and newborn care practices and services in developing countries. Investigators planned to evaluate the impact of a low-cost package of community-based interventions implemented through government sector lady health workers (LHWs) and community health workers (CHWs) of a NGO namely Aga Khan Health Services on perinatal and neonatal outcomes in a sub-population of the remote mountainous district of Gilgit, Northern Pakistan.

A community-based package for use by LHWs and CHWs geared towards prevention and promotion of maternal and newborn health practices and services will be developed based on formative research in the study district. The package will include promotion of antenatal care, adequate nutrition, skilled delivery and healthy newborn care practices at household level. The health workers will be trained in recognition of danger sign that warrant referral to health care service. LHWs and CHWs will delivered the package via community awareness sessions and two one-to-one counselling sessions to pregnant women during third trimester and five newborn assessment visits in the neonatal period. In addition to this, community mobilization activities included formation of CHCs and creation of support for the uptake of the interventions. Control areas will continue to receive the routine standard health services of governmental and non-governmental organizations in the area. The intervention areas will receive the intervention package in addition to the routine standard health services. Outcome measures will include changes in maternal and newborn-care practices and perinatal and neonatal mortality rates between the intervention and control areas.


Options:
A: Inclusion Criteria:

* Documented history of previous preterm delivery. Defined as delivery from 20 weeks to 36 weeks 6 days gestation.
* Proven pregnancy
* Reside in Davidson County, Tennessee (TN) or surrounding county in 90 mile driving radius.
* Less than 24 weeks gestation at enrollment
* Will receive prenatal care at a Vnderbilt University Medical Center (VUMC) clinic
* Willing to accept nurse home visits and be randomly assigned to conventional care or care with home visits
* Speaks and understands English
* Between the ages of 18 and 40 years.

Exclusion Criteria:

* Known fetal anomaly that can not be managed conservatively or fetal demise
* Maternal medical or obstetrical complications including:

  * Current or scheduled cervical cerclage
  * PROM in current pregnancy prior to enrollment
* Participation in an antenatal study in which the clinical status or intervention may influence gestational age at delivery
* Profound mental dysfunction or under guardianship
B: Inclusion Criteria:

* Pregnant
* Able to attend group treatment sessions conducted in English or Spanish

Exclusion Criteria:

* Positive HIV infection
* Severe medical problem requiring individualized assessment and tracking as high-risk pregnancy
C: Inclusion Criteria:

* 18 years of age or older
* Between 6-30 weeks pregnant
* Enrolled as a patient at the local health department (LHD) or Brody School of Medicine Regional Perinatal Center (BSOM-RPC)
* Self-identified as African American, Caucasian, or Hispanic
* Able to read at a 4th grade level;
* Have a or score \>4 on the Edinburgh Postnatal Depression Scale (EPDS)
* Are willing to complete the informed consent form
* Enrolled in Medicaid or are low-income based on Women's Infant and Children (WIC) eligibility criteria.

Exclusion Criteria:

* Have had a spontaneous abortion before 20 weeks of pregnancy
* Diagnosed with schizophrenia or bipolar disorder with or without psychosis, or are currently receiving treatment for depression; or have an organic mental disorder
* Diagnosed with a high-risk pregnancy that requires bed rest or hospitalization-- Demonstrated an active suicidal plan
* Had a concurrent medical condition, such as hypothyroidism, that would explain depression.
D: Inclusion Criteria:

* Pregnant women \& participants who agree to participate in the study

Exclusion Criteria:

* Pregnant women \& participants who disagree to participate in the study

Answer: D