Houweling Tanja A J, Morrison Joanna, Alcock Glyn, Azad Kishwar, Das Sushmita, Hossen Munir, Kuddus Abdul, Lewycka Sonia, Looman Caspar W, Magar Bharat Budhathoki, Manandhar Dharma S, Akter Mahfuza, Dube Albert Lazarous Nkhata, Rath Shibanand, Saville Naomi, Sen Aman, Tripathy Prasanta, Costello Anthony
Institute for Global Health, University College London, London, UK Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
Institute for Global Health, University College London, London, UK.
J Epidemiol Community Health. 2016 Jan;70(1):31-41. doi: 10.1136/jech-2014-204685. Epub 2015 Aug 5.
Efforts to end preventable newborn deaths will fail if the poor are not reached with effective interventions. To understand what works to reach vulnerable groups, we describe and explain the uptake of a highly effective community-based newborn health intervention across social strata in Asia and Africa.
We conducted a secondary analysis of seven randomised trials of participatory women's groups to reduce newborn mortality in India, Bangladesh, Nepal and Malawi. We analysed data on 70,574 pregnancies. Socioeconomic and sociodemographic differences in group attendance were tested using logistic regression. Qualitative data were collected at each trial site (225 focus groups, 20 interviews) to understand our results.
Socioeconomic differences in women's group attendance were small, except for occasional lower attendance by elites. Sociodemographic differences were large, with lower attendance by young primigravid women in African as well as in South Asian sites. The intervention was considered relevant and interesting to all socioeconomic groups. Local facilitators ensured inclusion of poorer women. Embarrassment and family constraints on movement outside the home restricted attendance among primigravid women. Reproductive health discussions were perceived as inappropriate for them.
Community-based women's groups can help to reach every newborn with effective interventions. Equitable intervention uptake is enhanced when facilitators actively encourage all women to attend, organise meetings at the participants' convenience and use approaches that are easily understandable for the less educated. Focused efforts to include primigravid women are necessary, working with families and communities to decrease social taboos.
如果未能为贫困人口提供有效的干预措施，那么终结可预防的新生儿死亡的努力将会失败。为了解何种措施有助于覆盖弱势群体，我们描述并解释了一项基于社区的高效新生儿健康干预措施在亚洲和非洲不同社会阶层中的推广情况。
我们对印度、孟加拉国、尼泊尔和马拉维开展的七项关于参与式妇女团体以降低新生儿死亡率的随机试验进行了二次分析。我们分析了70574例妊娠的数据。使用逻辑回归检验团体参与率在社会经济和社会人口统计学方面的差异。在每个试验地点收集定性数据（225个焦点小组，20次访谈）以理解我们的研究结果。
妇女团体参与率在社会经济方面的差异较小，只是精英群体偶尔参与率较低。社会人口统计学方面的差异较大，在非洲以及南亚地区，年轻初产妇的参与率较低。该干预措施被认为对所有社会经济群体都具有相关性和吸引力。当地的协调员确保了贫困妇女的参与。尴尬以及家庭对出门活动的限制使得初产妇参与率较低。生殖健康讨论被认为对她们不合适。
基于社区的妇女团体有助于通过有效的干预措施覆盖每一位新生儿。当协调员积极鼓励所有妇女参与、在参与者方便的时候组织会议并采用教育程度较低者易于理解的方法时，干预措施的公平推广会得到加强。有必要集中力量让初产妇参与进来，与家庭和社区合作以减少社会禁忌。
