Cargando…
Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens
BACKGROUND: Despite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India. METHODS: Utilising survey-weig...
Autores principales: | , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Society of Global Health
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759017/ https://www.ncbi.nlm.nih.gov/pubmed/33425335 http://dx.doi.org/10.7189/jogh.10.021011 |
_version_ | 1783627046009700352 |
---|---|
author | Ward, Victoria C Weng, Yingjie Bentley, Jason Carmichael, Suzan L Mehta, Kala M Mahmood, Wajeeha Pepper, Kevin T Abdalla, Safa Atmavilas, Yamini Mahapatra, Tanmay Srikantiah, Sridhar Borkum, Evan Rangarajan, Anu Sridharan, Swetha Rotz, Dana Bhattacharya, Debarshi Nanda, Priya Tarigopula, Usha Kiran Shah, Hemant Darmstadt, Gary L |
author_facet | Ward, Victoria C Weng, Yingjie Bentley, Jason Carmichael, Suzan L Mehta, Kala M Mahmood, Wajeeha Pepper, Kevin T Abdalla, Safa Atmavilas, Yamini Mahapatra, Tanmay Srikantiah, Sridhar Borkum, Evan Rangarajan, Anu Sridharan, Swetha Rotz, Dana Bhattacharya, Debarshi Nanda, Priya Tarigopula, Usha Kiran Shah, Hemant Darmstadt, Gary L |
author_sort | Ward, Victoria C |
collection | PubMed |
description | BACKGROUND: Despite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India. METHODS: Utilising survey-weighted logistic regression, we estimated programmatic impact using difference-in-difference estimators from Mathematica data collected at the beginning (2012, n = 10 174) and after two years of program implementation (2014, n = 9611). We also examined changes in disparities over time using eight rounds of Community-based Household Surveys (CHS) (2012-2017, n = 48 349) collected by CARE India. RESULTS: At baseline for the Mathematica data, least marginalised women generally performed desired health-related behaviours more frequently than the most marginalised. After two years, most disparities persisted. Disparities increased for skilled birth attendant identification [+16.2% (most marginalised) vs +32.6% (least marginalized), P < 0.01) and skin-to-skin care (+14.8% vs +20.4%, P < 0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9, P < 0.01). For the CHS data, odds ratios compared the most to the least marginalised women as referent. Results demonstrated that disparities were most significant for indicators reliant on access to care such as delivery in a facility (OR range: 0.15 to 0.48) or by a qualified doctor (OR range: 0.08 to 0.25), and seeking care for complications (OR range: 0.26 to 0.64). CONCLUSIONS: Disparities observed at baseline generally persisted throughout program implementation. The most significant disparities were observed amongst behaviours dependent upon access to care. Changes in disparities largely were due to improvements for the least marginalised women without improvements for the most marginalised. Equity-based assessments of programmatic impacts, including those of universal health approaches, must be undertaken to monitor disparities and to ensure equitable and sustainable benefits for all. STUDY REGISTRATION: ClinicalTrials.gov number NCT02726230 |
format | Online Article Text |
id | pubmed-7759017 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | International Society of Global Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-77590172021-01-07 Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens Ward, Victoria C Weng, Yingjie Bentley, Jason Carmichael, Suzan L Mehta, Kala M Mahmood, Wajeeha Pepper, Kevin T Abdalla, Safa Atmavilas, Yamini Mahapatra, Tanmay Srikantiah, Sridhar Borkum, Evan Rangarajan, Anu Sridharan, Swetha Rotz, Dana Bhattacharya, Debarshi Nanda, Priya Tarigopula, Usha Kiran Shah, Hemant Darmstadt, Gary L J Glob Health Research Theme 6: Learning from Ananya Program in Bihar BACKGROUND: Despite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India. METHODS: Utilising survey-weighted logistic regression, we estimated programmatic impact using difference-in-difference estimators from Mathematica data collected at the beginning (2012, n = 10 174) and after two years of program implementation (2014, n = 9611). We also examined changes in disparities over time using eight rounds of Community-based Household Surveys (CHS) (2012-2017, n = 48 349) collected by CARE India. RESULTS: At baseline for the Mathematica data, least marginalised women generally performed desired health-related behaviours more frequently than the most marginalised. After two years, most disparities persisted. Disparities increased for skilled birth attendant identification [+16.2% (most marginalised) vs +32.6% (least marginalized), P < 0.01) and skin-to-skin care (+14.8% vs +20.4%, P < 0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9, P < 0.01). For the CHS data, odds ratios compared the most to the least marginalised women as referent. Results demonstrated that disparities were most significant for indicators reliant on access to care such as delivery in a facility (OR range: 0.15 to 0.48) or by a qualified doctor (OR range: 0.08 to 0.25), and seeking care for complications (OR range: 0.26 to 0.64). CONCLUSIONS: Disparities observed at baseline generally persisted throughout program implementation. The most significant disparities were observed amongst behaviours dependent upon access to care. Changes in disparities largely were due to improvements for the least marginalised women without improvements for the most marginalised. Equity-based assessments of programmatic impacts, including those of universal health approaches, must be undertaken to monitor disparities and to ensure equitable and sustainable benefits for all. STUDY REGISTRATION: ClinicalTrials.gov number NCT02726230 International Society of Global Health 2020-12 2020-12-19 /pmc/articles/PMC7759017/ /pubmed/33425335 http://dx.doi.org/10.7189/jogh.10.021011 Text en Copyright © 2020 by the Journal of Global Health. All rights reserved. http://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License. |
spellingShingle | Research Theme 6: Learning from Ananya Program in Bihar Ward, Victoria C Weng, Yingjie Bentley, Jason Carmichael, Suzan L Mehta, Kala M Mahmood, Wajeeha Pepper, Kevin T Abdalla, Safa Atmavilas, Yamini Mahapatra, Tanmay Srikantiah, Sridhar Borkum, Evan Rangarajan, Anu Sridharan, Swetha Rotz, Dana Bhattacharya, Debarshi Nanda, Priya Tarigopula, Usha Kiran Shah, Hemant Darmstadt, Gary L Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens |
title | Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens |
title_full | Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens |
title_fullStr | Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens |
title_full_unstemmed | Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens |
title_short | Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens |
title_sort | evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in bihar, india, through an equity lens |
topic | Research Theme 6: Learning from Ananya Program in Bihar |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759017/ https://www.ncbi.nlm.nih.gov/pubmed/33425335 http://dx.doi.org/10.7189/jogh.10.021011 |
work_keys_str_mv | AT wardvictoriac evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT wengyingjie evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT bentleyjason evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT carmichaelsuzanl evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT mehtakalam evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT mahmoodwajeeha evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT pepperkevint evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT abdallasafa evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT atmavilasyamini evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT mahapatratanmay evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT srikantiahsridhar evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT borkumevan evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT rangarajananu evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT sridharanswetha evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT rotzdana evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT bhattacharyadebarshi evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT nandapriya evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT tarigopulaushakiran evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT shahhemant evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT darmstadtgaryl evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens AT evaluationofalargescalereproductivematernalnewbornandchildhealthandnutritionprograminbiharindiathroughanequitylens |