An experiment of health services and additional microcredit in 128 villages of Bangladesh.
An experiment of health services and additional microcredit in 128 villages of Bangladesh.
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DOI：
10.1186/s41043-022-00292-z
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发表时间：
2022-05-02
影响因子：
1.9
通讯作者：
Zimmerman, Linnea
中科院分区：
文献类型：
--
作者：
Becker, Stan;Amin, Ruhul;Chakraborty, Nirali;Zimmerman, Linnea
关键词：
文献中的研究发现，关于小额信贷对健康结果的影响，结果喜忧参半。在之前包括小额信贷和健康干预的五项实验研究中，有三项报告称健康状况或行为没有显著变化。这项研究的目的是测试增加小额信贷和提供基本保健服务的边际和交互影响。这项研究在孟加拉国农村的128个村庄进行了4细胞实验设计。对于一个单元中的村庄，分配了一名额外的小额信贷工作人员。对于那些住在第二个牢房的人，一名卫生助理每月走访家庭，提供简单的药品，并宣布每月在每个村庄开设卫星诊所。对于第三个牢房，两种干预措施被结合起来，第四个牢房中的村庄作为对照。完成了基线调查，并在三年后进行了后续调查。结果措施是粮食安全、避孕措施的使用、在最后一次分娩时配备训练有素的助产士和麻疹免疫接种。对四项成果衡量标准(3787户家庭(完成率96%)和3687名妇女(完成率94%))的后续行动与基线水平的比较表明，所有研究部门的粮食安全都有了显著改善，卫生服务村最后一次分娩时训练有素的助产士人数显著增加。由于乡村银行内部对哪些工作人员将提供额外的小额信贷工作感到困惑，这一干预措施实施得很差，因此在多变量分析中，干预部门的数据与对照部门的数据进行了分组。以随访结果值为因变量，研究臂和女性文化程度为协变量的Logistic回归分析显示，单独研究臂或分组研究臂均无显著影响。三种健康行为中有两种没有随着时间的推移而显着改变，但在卫生服务部门，在最后一次分娩时有受过培训的助产士确实显着增加了。因此，社区健康教育有时可以有效地促进健康行为。这是一项现场试验，而不是临床试验，因此试验注册是不必要的。
Studies in the literature have found mixed results on the effect of microcredit on health outcomes. Of the five previous experimental studies that included microcredit and a health intervention, three reported no significant changes in health status or behaviors. The purpose of this study was to test for marginal and interactive effects of increased microcredit and provision of basic health services. This study had a 4-celled experimental design in 128 villages in rural Bangladesh. For villages in one cell, an additional microcredit worker was assigned. For those in a second cell, a health assistant visited households each month, provided simple medicines and announced a satellite clinic held monthly in each village. For a third cell, both interventions were combined, and villages in a fourth cell served as control. A baseline survey was completed and a follow-up survey was done three years later. Outcome measures were food security, contraceptive use, having a trained birth attendant at last birth, and measles immunization. Comparison of follow-up with baseline levels of the four outcome measures (for 3787 households (96% completeness) and 3687 women (94% completeness)) showed significant improvement in food security in all study arms and a significant increase in trained birth attendant at last birth in the health services villages. Due to confusion within Grameen Bank about which workers would provide the additional microcredit work, that intervention was poorly implemented so in multivariate analyses, the data for that intervention arm were grouped with data from the control arm. Logistic regression with values of the outcomes at follow-up as dependent variable and study arm and women’s schooling as covariates showed no significant effects of either separate or grouped study arms. Two of the three health behaviors showed no significant changes over time but having a trained birth attendant at last delivery did increase significantly in the health services arm. Therefore, community health education can sometimes be effective in promoting healthy behaviors. This was a field trial rather than a clinical trial, so trial registration was unnecessary.
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