Department of Population, Family and Reproductive Health, Johns Hopkins University, Baltimore, MD, USA.
Director of Research and Technical Assistance, Metrics for Management, Baltimore, MD, USA.
J Health Popul Nutr. 2022 May 2;41(1):14. doi: 10.1186/s41043-022-00292-z.
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.
文献中的研究对小额信贷对健康结果的影响得出了混合的结果。在之前纳入小额信贷和健康干预的五项实验研究中，有三项研究报告称健康状况或行为没有显著变化。本研究的目的是检验增加小额信贷和提供基本卫生服务的边际和交互效应。
本研究在孟加拉国农村的 128 个村庄进行了 4 细胞实验设计。对于一个细胞中的村庄，额外分配了一名小额信贷工作人员。对于第二个细胞中的村庄，每月有一名卫生助理家访，提供简单的药物，并宣布每月在每个村庄举行一次卫星诊所。对于第三个细胞，同时进行了这两种干预，第四个细胞的村庄作为对照。完成基线调查，并在三年后进行随访调查。结果衡量标准是粮食安全、避孕措施的使用、上次分娩时有经过培训的接生员以及麻疹免疫接种。
对四项结果衡量标准（3787 户家庭（96%完整）和 3687 名妇女（94%完整））的随访与基线水平进行比较，发现所有研究组的粮食安全状况都有显著改善，在提供卫生服务的村庄，上次分娩时有经过培训的接生员的比例显著增加。由于格莱珉银行内部对谁来提供额外的小额信贷工作存在混淆，该干预措施执行不力，因此在多变量分析中，该干预措施组的数据与对照组的数据合并。将随访时的结果值作为因变量，将研究组和妇女受教育程度作为协变量的逻辑回归显示，单独或合并的研究组均无显著影响。
三项健康行为中的两项在时间上没有显著变化，但在提供卫生服务的组中，上次分娩时有经过培训的接生员的比例显著增加。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，因此不需要试验注册。
