Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India: a difference-in-differences analysis
Effect of Chiranjeevi Yojana on institutional deliveries and neonatal and maternal outcomes in Gujarat, India: a difference-in-differences analysis
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DOI：
10.2471/blt.13.124644
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发表时间：
2014-03-01
影响因子：
11.1
通讯作者：
Miller, Grant
中科院分区：
文献类型：
--
作者：
Mohanan, Manoj;Bauhoff, Sebastian;Miller, Grant
目的评价Chiranjeevi Yojana方案的效果，该方案是一项旨在改善印度古吉拉特邦孕产妇和新生儿健康的公私伙伴关系。方法在古吉拉特邦进行住户调查（5597户），收集过去5年内出生情况的回顾性资料。在一项采用差异中差异设计的观察性研究中，随后检查了Chiranjeevi Yojana方案与在保健机构分娩的概率、产科并发症的概率和平均家庭分娩支出之间的关系。在多元回归中，控制了个体和家庭特征以及地区和年份固定效应。平行分析使用了最近在古吉拉特邦（n=6484户）进行的区级住户和设施调查（DLHS-3）波的数据。2005年至2010年间，Chiranjeevi Yojana项目与机构分娩概率（2.42个百分点；95%可信区间，CI: -5.90至10.74）或出生相关并发症（6.16个百分点，95% CI: -2.63至14.95）的统计学显著变化无关。使用DLHS-3数据的估计是相似的。对家庭支出的分析表明，在Chiranjeevi Yojana方案下，私营部门交付的平均家庭支出要么没有下降，要么几乎没有下降。Chiranjeevi Yojana方案似乎对机构分娩率或孕产妇健康结果没有显著影响。家庭在私营部门送货方面的支出估计没有减少，这一点值得进一步研究。
Objective To evaluate the effect of the Chiranjeevi Yojana programme, a public private partnership to improve maternal and neonatal health in Gujarat, India.Methods A household survey (n=5597 households) was conducted in Gujarat to collect retrospective data on births within the preceding 5 years. In an observational study using a difference-in-differences design, the relationship between the Chiranjeevi Yojana programme and the probability of delivery in health-care institutions, the probability of obstetric complications and mean household expenditure for deliveries was subsequently examined. In multivariate regressions, individual and household characteristics as well as district and year fixed effects were controlled for. Data from the most recent District Level Household and Facility Survey (DLHS-3) wave conducted in Gujarat (n=6484 households) were used in parallel analyses.Findings Between 2005 and 2010, the Chiranjeevi Yojana programme was not associated with a statistically significant change in the probability of institutional delivery (2.42 percentage points; 95% confidence interval, CI: -5.90 to 10.74) or of birth-related complications (6.16 percentage points; 95% CI: -2.63 to 14.95). Estimates using DLHS-3 data were similar. Analyses of household expenditures indicated that mean household expenditure for private-sector deliveries had either not fallen or had fallen very little under the Chiranjeevi Yojana programme.Conclusion The Chiranjeevi Yojana programme appears to have had no significant impact on institutional delivery rates or maternal health outcomes. The absence of estimated reductions in household spending for private-sector deliveries deserves further study.