Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens
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. Utilising survey-weighted logistic regress...
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| Veröffentlicht in: | Journal of global health 2020-12, Vol.10 (2), p.021011 |
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| creator | 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 |
| description | 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.
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.
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),
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| doi_str_mv | 10.7189/jogh.10.0201011 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_crossref_primary_10_7189_jogh_10_0201011</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>33425335</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1501-3d8418ce053331338c579faa046f89c43a230ae2001f6afb4526cd865c731a723</originalsourceid><addsrcrecordid>eNo9kMtOwzAQRS0EolXpmh3yByStH3k4S6gKVKrEBtbRxHESV45TnKSov8BXk7Sls5m5o7lXmoPQIyWLmIpkuWvKajEIwggllN6gKSNB7LNERLfXORYTNG_bHRkqppyJ6B5NOA9YyHk4Rb_rA5geOt1Y3BQYsAFXKr-VYBR2au-avJedPigP19ApZ8F42KqfrHEWg82xrLTJcaXAdNVpYfvO6VPeYC4d1Fhb_KIrcB7e2FyDh7vKNX05nmP13evuiI2y7QO6K8C0an7pM_T1uv5cvfvbj7fN6nnrSxoS6vNcBFRIRYYHOOVcyDBOCgASRIVIZMCBcQKKEUKLCIosCFkkcxGFMuYUYsZnaHnOla5pW6eKdO90De6YUpKOYNMR7CguYAfH09mx77Na5df7f4z8DwUKdPw</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens</title><source>MEDLINE</source><source>DOAJ Directory of Open Access Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>PubMed Central Open Access</source><source>PubMed Central</source><creator>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</creator><creatorcontrib>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 ; Ananya Study Group</creatorcontrib><description>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.
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.
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),
< 0.01) and skin-to-skin care (+14.8% vs +20.4%,
< 0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9,
< 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).
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.
ClinicalTrials.gov number NCT02726230.</description><identifier>ISSN: 2047-2978</identifier><identifier>EISSN: 2047-2986</identifier><identifier>DOI: 10.7189/jogh.10.0201011</identifier><identifier>PMID: 33425335</identifier><language>eng</language><publisher>Scotland</publisher><subject>Child Health ; Female ; Health Behavior ; Health Promotion ; Healthcare Disparities ; Humans ; India ; Infant ; Infant Health ; Infant, Newborn ; Male ; Maternal Health ; Maternal Health Services ; Nutritional Status ; Pregnancy ; Reproductive Health</subject><ispartof>Journal of global health, 2020-12, Vol.10 (2), p.021011</ispartof><rights>Copyright © 2020 by the Journal of Global Health. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1501-3d8418ce053331338c579faa046f89c43a230ae2001f6afb4526cd865c731a723</citedby><cites>FETCH-LOGICAL-c1501-3d8418ce053331338c579faa046f89c43a230ae2001f6afb4526cd865c731a723</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,865,27929,27930</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33425335$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ward, Victoria C</creatorcontrib><creatorcontrib>Weng, Yingjie</creatorcontrib><creatorcontrib>Bentley, Jason</creatorcontrib><creatorcontrib>Carmichael, Suzan L</creatorcontrib><creatorcontrib>Mehta, Kala M</creatorcontrib><creatorcontrib>Mahmood, Wajeeha</creatorcontrib><creatorcontrib>Pepper, Kevin T</creatorcontrib><creatorcontrib>Abdalla, Safa</creatorcontrib><creatorcontrib>Atmavilas, Yamini</creatorcontrib><creatorcontrib>Mahapatra, Tanmay</creatorcontrib><creatorcontrib>Srikantiah, Sridhar</creatorcontrib><creatorcontrib>Borkum, Evan</creatorcontrib><creatorcontrib>Rangarajan, Anu</creatorcontrib><creatorcontrib>Sridharan, Swetha</creatorcontrib><creatorcontrib>Rotz, Dana</creatorcontrib><creatorcontrib>Bhattacharya, Debarshi</creatorcontrib><creatorcontrib>Nanda, Priya</creatorcontrib><creatorcontrib>Tarigopula, Usha Kiran</creatorcontrib><creatorcontrib>Shah, Hemant</creatorcontrib><creatorcontrib>Darmstadt, Gary L</creatorcontrib><creatorcontrib>Ananya Study Group</creatorcontrib><title>Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens</title><title>Journal of global health</title><addtitle>J Glob Health</addtitle><description>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.
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.
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),
< 0.01) and skin-to-skin care (+14.8% vs +20.4%,
< 0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9,
< 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).
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.
ClinicalTrials.gov number NCT02726230.</description><subject>Child Health</subject><subject>Female</subject><subject>Health Behavior</subject><subject>Health Promotion</subject><subject>Healthcare Disparities</subject><subject>Humans</subject><subject>India</subject><subject>Infant</subject><subject>Infant Health</subject><subject>Infant, Newborn</subject><subject>Male</subject><subject>Maternal Health</subject><subject>Maternal Health Services</subject><subject>Nutritional Status</subject><subject>Pregnancy</subject><subject>Reproductive Health</subject><issn>2047-2978</issn><issn>2047-2986</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kMtOwzAQRS0EolXpmh3yByStH3k4S6gKVKrEBtbRxHESV45TnKSov8BXk7Sls5m5o7lXmoPQIyWLmIpkuWvKajEIwggllN6gKSNB7LNERLfXORYTNG_bHRkqppyJ6B5NOA9YyHk4Rb_rA5geOt1Y3BQYsAFXKr-VYBR2au-avJedPigP19ApZ8F42KqfrHEWg82xrLTJcaXAdNVpYfvO6VPeYC4d1Fhb_KIrcB7e2FyDh7vKNX05nmP13evuiI2y7QO6K8C0an7pM_T1uv5cvfvbj7fN6nnrSxoS6vNcBFRIRYYHOOVcyDBOCgASRIVIZMCBcQKKEUKLCIosCFkkcxGFMuYUYsZnaHnOla5pW6eKdO90De6YUpKOYNMR7CguYAfH09mx77Na5df7f4z8DwUKdPw</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Ward, Victoria C</creator><creator>Weng, Yingjie</creator><creator>Bentley, Jason</creator><creator>Carmichael, Suzan L</creator><creator>Mehta, Kala M</creator><creator>Mahmood, Wajeeha</creator><creator>Pepper, Kevin T</creator><creator>Abdalla, Safa</creator><creator>Atmavilas, Yamini</creator><creator>Mahapatra, Tanmay</creator><creator>Srikantiah, Sridhar</creator><creator>Borkum, Evan</creator><creator>Rangarajan, Anu</creator><creator>Sridharan, Swetha</creator><creator>Rotz, Dana</creator><creator>Bhattacharya, Debarshi</creator><creator>Nanda, Priya</creator><creator>Tarigopula, Usha Kiran</creator><creator>Shah, Hemant</creator><creator>Darmstadt, Gary L</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>202012</creationdate><title>Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens</title><author>Ward, Victoria C ; 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We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India.
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.
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),
< 0.01) and skin-to-skin care (+14.8% vs +20.4%,
< 0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9,
< 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).
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.
ClinicalTrials.gov number NCT02726230.</abstract><cop>Scotland</cop><pmid>33425335</pmid><doi>10.7189/jogh.10.0201011</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central Open Access; PubMed Central |
| subjects | Child Health Female Health Behavior Health Promotion Healthcare Disparities Humans India Infant Infant Health Infant, Newborn Male Maternal Health Maternal Health Services Nutritional Status Pregnancy Reproductive Health |
| title | Evaluation of a large-scale reproductive, maternal, newborn and child health and nutrition program in Bihar, India, through an equity lens |
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