Health equity impact of community-initiated kangaroo mother care: a randomized controlled trial

International Journal for Equity in Health

Kjell Arne Johansson¹  Jose Martines²  Ole F Norheim³  Halvor Sommerfelt⁴  Øystein Ariansen Haaland⁵  Rajiv Bahl⁶  Maharaj Kishan Bhan⁷  Nita Bhandari⁸  Sarmila Mazumder⁸  Sunita Taneja⁸  Tarun Shankar Choudhary⁹ 

[1] Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Bergen Centre for Ethics and Priority Setting, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Centre for Intervention Science in Maternal and Child Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Cluster for Global Health, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway;Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland;Indian Institute of Technology, New Delhi, India;Society for Applied Studies, Centre for Health Research and Development, New Delhi, India;Society for Applied Studies, Centre for Health Research and Development, New Delhi, India;Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway;

关键词: Kangaroo Mother Care;    Community;    Neonatal;    Infant;    Equity;    Randomized controlled trial;   

DOI  :  10.1186/s12939-021-01605-0

来源: Springer

【 摘 要 】

BackgroundKangaroo mother care (KMC) can substantially enhance overall survival of low birthweight babies. In a large randomized controlled trial, we recently showed that supporting mothers to provide community initiated KMC (ciKMC) can reduce mortality among infants up to 180 days of life by 25% (hazard ratio (HR) 0.75). With the current analysis, we aimed to explore if ciKMC promotion leads to increased inequity in survival.MethodsIn the trial we randomized 8402 low birthweight babies to a ciKMC (4480 babies) and a control (3922 babies) arm, between 2015 and 2018 in Haryana, India. We estimated the difference in concentration indices, which measure inequality, between babies in the ciKMC and control arms for survival until 180 days of life. Further, we compared the effect of ciKMC promotion across subgroups defined by socioeconomic status, caste, maternal literacy, infant’s sex, and religion.ResultsOur intervention did not increase survival inequity, as the concentration index in the ciKMC arm of the trial was 0.05 (95% CI -0.07 to 0.17) lower than in the control arm. Survival impact was higher among those belonging to the lower two wealth quintiles, those born to illiterate mothers and those belonging to religions other than Hindu.ConclusionsWe found that ciKMC promotion did not increase inequity in survival associated with wealth. The beneficial impact of ciKMC tended to be larger among vulnerable groups. Supporting mothers to provide KMC at home to low birthweight babies will not increase and could indeed reduce inequities in infant survival.Trial registrationClinicalTrials.gov, NCT02653534. Registered January 12, 2016—Retrospectively registered.

【 授权许可】

CC BY