Community-Based Interventions for the Poor: A Useful Tool to Reduce Newborn Mortality in Asia and Africa

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Topic(s): Nutrition Health & Wellness Obesity Nutrition & Disease Management

Use of Health Interventions by Women’s Groups in Tackling Newborn Mortality: An Analysis of Seven Randomised Trials in Asia and Africa

Community-based interventions help in the improvement of maternal and newborn health. However, chances of excluding the lower strata and capturing the elite carry a risk in which the locally powerful use interventions to their benefit. Trials using participatory women’s groups provide an opportunity to collect evidence to address this issue of exclusion of lower social strata from health interventions. Houweling et al conducted an analysis using data from seven trials to describe the socioeconomic and sociodemographic inequalities in the uptake of community-based interventions to reduce newborn mortality in Asia and Africa and how to reduce inequalities. This study was published in the Journal of Epidemiology and Community Health.

This secondary analysis included seven cluster randomised trials of participatory women’s groups. Data were analysed from 70,574 pregnancies. Attendance at the women’s groups was the main outcome, which was examined in socioeconomic and sociodemographic dimensions. Maternal education and household economic status were the measures of socioeconomic position. Participation in community-based interventions formed the sociodemographic determinant.

Socioeconomic differences in women’s group were small, with lower attendance seen among the elite. Sociodemographic differences were large, with lower attendance seen among young and primigravid women in African and South Asian sites. The local facilitators promoted inclusivity into community-based interventions by encouraging poorer women to attend. The intervention design was easily understood by less-educated women and included information and discussion about reproductive health that the women were interested in engaging with. Embarrassment in discussing reproductive health and family constraints on movement outside the home posed as challenges in attendance among primigravid women.

Specific research and policy attention are, therefore, required to address the lower uptake of community-based interventions among young primigravid women. Nevertheless, community-based approaches through women’s groups are helpful in reaching every newborn by involving facilitators who ensure equitable intervention uptake.

News source - Houweling TA, Morrison J, Alcock G, et al. Reaching the poor with health interventions: programme-incidence analysis of seven randomised trials of women's groups to reduce newborn mortality in Asia and Africa. Journal of Epidemiology and Community Health. 2016 Jan;70(1):31-41.