The objective of this study was to overcome the three delays in triage, transport and treatment that underlie adverse pregnancy outcomes with community-level interventions targeting women with pregnancy hypertension in three low-income countries. In this individual participant-level meta-analysis, the authors de-identified and pooled data from the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trials in Mozambique, Pakistan, and India, which were run in 2014–17. The CLIP intervention did not reduce adverse pregnancy outcomes. Future community-level interventions should expand the community health worker workforce, assess general (rather than condition-specific) messaging, and include health system strengthening.


  1. Magee LA Sharma S Nathan HL et al. The incidence of pregnancy hypertension in India, Pakistan, Mozambique, and Nigeria: a prospective population-level analysis. PLoS Med. 2019; 16e1002783

  2. Steegers EA von Dadelszen P Duvekot JJ Pijnenborg R. Pre-eclampsia. Lancet. 2010; 376: 631-644

  3. GBD 2015 Maternal Mortality Collaborators. Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016; 388: 1775-1812


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