title: 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.
abstract: BACKGROUND
  Efforts to end preventable newborn deaths will fail if the poor are not reached with effective interventions. To understand what works to reach vulnerable groups, we describe and explain the uptake of a highly effective community-based newborn health intervention across social strata in Asia and Africa.
  
  
  METHODS
  We conducted a secondary analysis of seven randomised trials of participatory women's groups to reduce newborn mortality in India, Bangladesh, Nepal and Malawi. We analysed data on 70,574 pregnancies. Socioeconomic and sociodemographic differences in group attendance were tested using logistic regression. Qualitative data were collected at each trial site (225 focus groups, 20 interviews) to understand our results.
  
  
  RESULTS
  Socioeconomic differences in women's group attendance were small, except for occasional lower attendance by elites. Sociodemographic differences were large, with lower attendance by young primigravid women in African as well as in South Asian sites. The intervention was considered relevant and interesting to all socioeconomic groups. Local facilitators ensured inclusion of poorer women. Embarrassment and family constraints on movement outside the home restricted attendance among primigravid women. Reproductive health discussions were perceived as inappropriate for them.
  
  
  CONCLUSIONS
  Community-based women's groups can help to reach every newborn with effective interventions. Equitable intervention uptake is enhanced when facilitators actively encourage all women to attend, organise meetings at the participants' convenience and use approaches that are easily understandable for the less educated. Focused efforts to include primigravid women are necessary, working with families and communities to decrease social taboos.
authors.affiliation: Institute for Global Health, University College London, London, UK Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Tanja A J
authors.initials: TA
authors.lastname: Houweling
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Joanna
authors.initials: J
authors.lastname: Morrison
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Glyn
authors.initials: G
authors.lastname: Alcock
authors.affiliation: Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh.
authors.forename: Kishwar
authors.initials: K
authors.lastname: Azad
authors.affiliation: Society for Nutrition, Education and Health Action (SNEHA), Urban Health Centre, Shahunagar, Dharavi, Mumbai, Maharashtra, India.
authors.forename: Sushmita
authors.initials: S
authors.lastname: Das
authors.affiliation: Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh.
authors.forename: Munir
authors.initials: M
authors.lastname: Hossen
authors.affiliation: Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh.
authors.forename: Abdul
authors.initials: A
authors.lastname: Kuddus
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Lewycka
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Caspar W
authors.initials: CW
authors.lastname: Looman
authors.affiliation: Mother and Infant Research Activities (MIRA), Kathmandu, Nepal.
authors.forename: Bharat Budhathoki
authors.initials: BB
authors.lastname: Magar
authors.affiliation: Mother and Infant Research Activities (MIRA), Kathmandu, Nepal.
authors.forename: Dharma S
authors.initials: DS
authors.lastname: Manandhar
authors.affiliation: Perinatal Care Project (PCP), Diabetic Association of Bangladesh (BADAS), Dhaka, Bangladesh.
authors.forename: Mahfuza
authors.initials: M
authors.lastname: Akter
authors.affiliation: MaiMwana Project, Mchinji, Malawi.
authors.forename: Albert Lazarous Nkhata
authors.initials: AL
authors.lastname: Dube
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Shibanand
authors.initials: S
authors.lastname: Rath
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Naomi
authors.initials: N
authors.lastname: Saville
authors.affiliation: Mother and Infant Research Activities (MIRA), Kathmandu, Nepal.
authors.forename: Aman
authors.initials: A
authors.lastname: Sen
authors.affiliation: Ekjut, Chakradharpur, Jharkhand, India.
authors.forename: Prasanta
authors.initials: P
authors.lastname: Tripathy
authors.affiliation: Institute for Global Health, University College London, London, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
mesh_terms: D000328:Adult; D001211:Asia, Western / Q000453:epidemiology; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000517:prevention & control; D008295:Malawi / Q000453:epidemiology; D011203:Poverty; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D012959:Socioeconomic Factors; D035862:Vulnerable Populations; D055815:Young Adult
keywords: HEALTH BEHAVIOUR; Health inequalities; INTERNATIONAL HLTH; NEONATAL; REPRODUCTIVE HEALTH