Hazra Avishek, Atmavilas Yamini, Hay Katherine, Saggurti Niranjan, Verma Raj Kumar, Ahmad Jaleel, Kumar Sampath, Mohanan P S, Mavalankar Dileep, Irani Laili
Population Council, New Delhi, India.
Bill & Melinda Gates Foundation, New Delhi, India.
EClinicalMedicine. 2019 Nov 20;18:100198. doi: 10.1016/j.eclinm.2019.10.011. eCollection 2020 Jan.
Despite the health system efforts, health disparities exist across sub-populations in India. We assessed the effects of health behaviour change interventions through women's self-help groups (SHGs) on maternal and newborn health (MNH) behaviours and socio-economic inequalities.
We did a quasi-experimental study of a large-scale SHG program in Uttar Pradesh, India, where 120 geographic blocks received, and 83 blocks did not receive health intervention. Data comes from two cross-sectional surveys with 4,615 recently delivered women in 2015, and 4,250 women in 2017. The intervention included MNH discussions in SHG meetings and community outreach activities. The outcomes included antenatal, natal and postnatal care, contraceptive use, cord care, skin-to-skin care, and breastfeeding practices. Effects were assessed using multilevel mixed-effects regression adjusted difference-in-differences (DID) analysis adjusting for geographic clustering and potential covariates, for all, most-marginalised and least-marginalised women. Concentration indices examined the socio-economic inequality in health practices over time.
The net improvements (5-11 percentage points [pp]) in correct MNH practices were significant in the intervention areas. The improvements over time were higher among the most-marginalised than least-marginalised for antenatal check-ups (DID: 20pp, <0•001 versus DID: 6pp, = 0•093), consumption of iron folic acid tablets for 100 days (DID: 7pp, = 0•036 versus DID: -1pp, = 0•671), current use of contraception (DID: 12pp, = 0•046 versus DID: 10pp, = 0•021), cord care (DID: 12pp, = 0•051 versus DID: 7pp, = 0•210), and timely initiation of breastfeeding (DID: 29pp, = 0•001 versus DID: 1pp, = 0•933). Lorenz curves and concentration indices indicated reduction in rich-poor gap in health practices over time in the intervention areas.
Disparities in MNH behaviours declined with the efforts by SHGs through behaviour change communication intervention.
尽管卫生系统做出了努力，但印度不同亚人群之间仍存在健康差距。我们评估了通过妇女自助小组（SHG）开展的健康行为改变干预措施对孕产妇和新生儿健康（MNH）行为以及社会经济不平等的影响。
我们在印度北方邦对一个大规模的SHG项目进行了准实验研究，其中120个地理区域接受了健康干预，83个区域未接受。数据来自2015年对4615名近期分娩妇女和2017年对4250名妇女的两次横断面调查。干预措施包括在SHG会议上进行的MNH讨论和社区外展活动。结果包括产前、产时和产后护理、避孕措施使用、脐带护理、皮肤接触护理和母乳喂养实践。使用多水平混合效应回归调整差异-in-差异（DID）分析评估影响，对所有、最边缘化和最不边缘化的妇女进行地理聚类和潜在协变量调整。集中度指数研究了健康实践中随时间变化的社会经济不平等情况。
在干预地区，正确的MNH实践的净改善（5 - 11个百分点[pp]）具有统计学意义。随着时间的推移，在产前检查方面，最边缘化人群的改善幅度高于最不边缘化人群（DID：20pp，<0.001对比DID：6pp，=0.093）；服用100天铁叶酸片方面（DID：7pp，=0.036对比DID：-1pp，=0.671）；当前避孕措施使用方面（DID：12pp，=0.046对比DID：10pp，=0.021）；脐带护理方面（DID：12pp，=0.051对比DID：7pp，=0.210）；以及及时开始母乳喂养方面（DID：29pp，=0.001对比DID：1pp，=0.933）。洛伦兹曲线和集中度指数表明，干预地区健康实践中的贫富差距随时间缩小。
通过行为改变沟通干预，SHG的努力使MNH行为方面的差距有所缩小。
