The equity impact of community women's groups to reduce neonatal mortality: a meta-analysis of four cluster randomized trials
The equity impact of community women's groups to reduce neonatal mortality: a meta-analysis of four cluster randomized trials
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DOI：
10.1093/ije/dyx160
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发表时间：
2019-02-01
影响因子：
7.7
通讯作者：
Costello, Anthony
中科院分区：
文献类型：
--
作者：
Houweling, Tanja A. J.;Looman, Caspar W. N.;Costello, Anthony
背景：新生儿死亡率的社会经济不平等在许多发展中国家是巨大的。关于如何解决这个问题，人们知之甚少。在亚洲和非洲进行的试验表明，妇女团体参与性学习和行动干预对新生儿死亡率产生了巨大影响。这种干预措施是否也能减少死亡率不平等仍不得而知。我们描述了公平的影响，这对新生儿死亡率（NMR）的妇女团体干预的社会经济阶层。方法：我们进行了荟萃分析，所有四个参与性的妇女团体干预措施，被证明是非常有效的，在印度，尼泊尔，孟加拉国和马拉维的集群随机试验。我们估计干预效果的NMR和健康行为的社会经济阶层较低和较高的随机效应逻辑回归分析。阶层之间的效果差异进行了tested.Results：69120活产和2505新生儿死亡的分析表明，干预措施大大降低了NMR在较低（50-63%，取决于所使用的社会经济地位的措施）和较高（35-44%）的社会经济阶层。干预没有显示出“精英捕获”的证据：在最边缘化的人群中，干预地区的NMR比对照地区低63%[95%置信区间（CI）48-74%]，而对照地区为35%。（95% CI：15-50%）在最后一个试验年中边缘化程度较低的患者中较低（边缘化程度最高/较低之间差异的P值：0.009）。干预措施大大改善了家庭护理的做法，没有系统的社会经济学差异effects.Conclusions的影响：高人口覆盖率的preparatory妇女团体受益于新生儿的生存机会，从所有的社会经济阶层，也许特别是那些出生在最贫困的家庭。
Background: Socioeconomic inequalities in neonatal mortality are substantial in many developing countries. Little is known about how to address this problem. Trials in Asia and Africa have shown strong impacts on neonatal mortality of a participatory learning and action intervention with women's groups. Whether this intervention also reduces mortality inequalities remains unknown. We describe the equity impact of this women's groups intervention on the neonatal mortality rate (NMR) across socioeconomic strata.Methods: We conducted a meta-analysis of all four participatory women's group interventions that were shown to be highly effective in cluster randomized trials in India, Nepal, Bangladesh and Malawi. We estimated intervention effects on NMR and health behaviours for lower and higher socioeconomic strata using random effects logistic regression analysis. Differences in effect between strata were tested.Results: Analysis of 69120 live births and 2505 neonatal deaths shows that the intervention strongly reduced the NMR in lower (50-63% reduction depending on the measure of socioeconomic position used) and higher (35-44%) socioeconomic strata. The intervention did not show evidence of 'elite-capture': among the most marginalized populations, the NMR in intervention areas was 63% lower [95% confidence interval (CI) 48-74%] than in control areas, compared with 35% (95% CI: 15-50%) lower among the less marginalized in the last trial year (P-value for difference between most/less marginalized: 0.009). The intervention strongly improved home care practices, with no systematic socioeconomic differences in effect.Conclusions: Participatory women's groups with high population coverage benefit the survival chances of newborns from all socioeconomic strata, and perhaps especially those born into the most deprived households.