Effect of Facilitation of Local Stakeholder Groups on Equity in Neonatal Survival; Results from the NeoKIP Trial in Northern Vietnam

Abstract

BackgroundTo operationalize the post-MDG agenda, there is a need to evaluate the effects of health interventions on equity. The aim of this study is to evaluate the effect on equity in neonatal survival of the NeoKIP trial (ISRCTN44599712), a population-based, cluster-randomized intervention trial with facilitated local stakeholder groups for improved neonatal survival in Quang Ninh province in northern Vietnam.MethodsSemi-structured interviews were conducted with all mothers experiencing neonatal mortality and a random sample of 6% of all mothers with a live birth in the study area during the study period (July 2008-June 2011). Multilevel regression analyses were performed, stratifying mothers according to household wealth, maternal education and mother’s ethnicity in order to assess impact on equity in neonatal survival.FindingsIn the last year of study the risk of neonatal death was reduced by 69% among poor mothers in the intervention area as compared to poor mothers in the control area (OR 0.31, 95% CI 0.15–0.66). This pattern was not evident among mothers from non-poor households. Mothers with higher education had a 50% lower risk of neonatal mortality if living in the intervention area during the same time period (OR 0.50, 95% CI 0.28–0.90), whereas no significant effect was detected among mothers with low education.InterpretationThe NeoKIP intervention promoted equity in neonatal survival based on wealth but increased inequity based on maternal education.

Effects of community health worker interventions on socioeconomic inequities in maternal and newborn health in low-income and middle-income countries: a mixed-methods systematic review

“…The interventions described in these articles fell into four broad types: home visits; community-based groups; cash transfers; mixed interventions involving multiple components, such as community meetings, media campaigns or community midwives. Some articles reported on the same interventions: four on participatory women’s groups in Northeast India,25–28 three on participatory women’s groups in Nepal26 27 29 and two on local stakeholder group interventions in Vietnam 30 31…”

“…Two articles based on six randomised controlled trials of a women’s group intervention reported pro-equitable effects on neonatal mortality across socioeconomic groups (recorded once in figure 3). 27 28 One trial evaluating community stakeholder groups also reported a pro-poor improvement in NMR in intervention compared with control areas among wealth quintiles but not education or ethnicity groups 31. One study of a national community health programme (in figure 3 included under ‘Mixed interventions’) found that the density of CHWs in poor areas had no association with NMR, whereas in richer areas there was an association with higher neonatal mortality 42…”

“…Three articles reported on the equity impact of group-based interventions on neonatal mortality 27 28 31. Two of these were, together, based on six of the women’s group randomised controlled trails mentioned above 27 28.…”

“…Houweling et al ’s high-quality meta-analysis of six trials of women’s groups found that the intervention led to a 63% decline (95% CI 48% to 73%) in the NMR among the most marginalised (illiterate and poorest wealth quintile), compared with a 35% decline (95% CI 15% to 50%) among the less marginalised 27. A high-quality cluster randomised controlled trial in Vietnam studied the Neonatal Health—Knowledge Into Practice (NeoKIP) group interventions, in which local stakeholders (commune health staff, women’s union members, lay health workers and local decision makers) discussed, developed and implemented strategies to improve maternal and newborn health 31. The intervention led to a 44% reduction (OR 0.56 (95% CI 0.36 to 0.89)) in neonatal mortality in the third intervention year.…”

Child survival revolutions revisited – lessons learned from Bangladesh, Nicaragua, Rwanda and Vietnam

“…In Vietnam, as well as in other Asian countries, intervention studies have shown that participatory approaches to community engagement can solve some of the local problems that threaten perinatal survival and thereby reduce neonatal mortality and increase equity in survival 30, 31, 32, 33. A number of organisations have played important roles in the child health revolutions in these countries, including the civil society and nongovernmental organisations in Bangladesh 23, the strong Women's Union in Vietnam 30 and communities that have engaged in development and welfare in Rwanda 6.…”