Målqvist Mats, Hoa Dinh Phuong Thi, Persson Lars-Åke, Ekholm Selling Katarina
International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Hanoi School of Public Health, Hanoi, Vietnam.
PLoS One. 2015 Dec 29;10(12):e0145510. doi: 10.1371/journal.pone.0145510. eCollection 2015.
To operationalize the post-MDG agenda, there is a need to evaluate the effects of health interventions on equity. The aim of this study is to evaluate the effect on equity in neonatal survival of the NeoKIP trial (ISRCTN44599712), a population-based, cluster-randomized intervention trial with facilitated local stakeholder groups for improved neonatal survival in Quang Ninh province in northern Vietnam.
Semi-structured interviews were conducted with all mothers experiencing neonatal mortality and a random sample of 6% of all mothers with a live birth in the study area during the study period (July 2008-June 2011). Multilevel regression analyses were performed, stratifying mothers according to household wealth, maternal education and mother's ethnicity in order to assess impact on equity in neonatal survival.
In the last year of study the risk of neonatal death was reduced by 69% among poor mothers in the intervention area as compared to poor mothers in the control area (OR 0.31, 95% CI 0.15-0.66). This pattern was not evident among mothers from non-poor households. Mothers with higher education had a 50% lower risk of neonatal mortality if living in the intervention area during the same time period (OR 0.50, 95% CI 0.28-0.90), whereas no significant effect was detected among mothers with low education.
The NeoKIP intervention promoted equity in neonatal survival based on wealth but increased inequity based on maternal education.
为实施千年发展目标后的议程，有必要评估卫生干预措施对公平性的影响。本研究的目的是评估NeoKIP试验（ISRCTN44599712）对新生儿生存公平性的影响，该试验是一项基于人群的整群随机干预试验，在越南北方广宁省设立了促进当地利益相关者参与的组织以提高新生儿生存率。
对所有经历新生儿死亡的母亲以及在研究期间期间（2008年7月至2011年6月）期间在研究地区有活产的所有母亲中随机抽取6%的样本进行了半结构化访谈。进行了多水平回归分析，根据家庭财富、母亲教育程度和母亲种族对母亲进行分层，以评估对新生儿生存公平性的影响。
在研究的最后一年，与对照地区的贫困母亲相比，干预地区贫困母亲的新生儿死亡风险降低了69%（比值比0.31，95%置信区间0.15 - 0.66）。这种模式在非贫困家庭的母亲中并不明显。同期居住在干预地区的受过高等教育的母亲，其新生儿死亡风险降低了50%（比值比0.50，95%置信区间0.28 - 0.90），而受教育程度低的母亲中未发现显著影响。
NeoKIP干预措施促进了基于财富的新生儿生存公平性，但增加了基于母亲教育程度的不公平性。
