title: Equity improvements in maternal and newborn care indicators: results from the Bardiya district of Nepal.
abstract: Community-based maternal and newborn care interventions have been shown to improve neonatal survival and other key health indicators. It is important to evaluate whether the improvement in health indicators is accompanied by a parallel increase in the equitable distribution of the intervention activities, and the uptake of healthy newborn care practices. We present an analysis of equity improvements after the implementation of a Community Based Newborn Care Package (CB-NCP) in the Bardiya district of Nepal. The package was implemented alongside other programs that were already in place within the district. We present changes in concentration indices (CIndices) as measures of changes in equity, as well as percentage changes in coverage, between baseline and endline. The CIndices were derived from wealth scores that were based on household assets, and they were compared usingt-tests. We observed statistically significant improvements in equity for facility delivery [CIndex: -0.15 (-0.24, -0.06)], knowledge of at least three newborn danger signs [-0.026(-0.06, -0.003)], breastfeeding within 1 h [-0.05(-0.11, -0.0001)], at least one antenatal visit with a skilled provider [-0.25(-0.04, -0.01)], at least four antenatal visits from any provider [-0.15(-0.19, -0.10)] and birth preparedness [-0.09(-0.12, -0.06)]. The largest increases in practices were observed for facility delivery (50%), immediate drying (34%) and delayed bathing (29%). These results and those of similar studies are evidence that community-based interventions delivered by female community health volunteers can be instrumental in improving equity in levels of facility delivery and other newborn care behaviours. We recommend that equity be evaluated in other similar settings within Nepal in order to determine if similar results are observed.
authors: International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, bnonyan1@jhu.edu.
authors: Bareng A S
authors: BA
authors: Nonyane
authors: Department of Women and Children, Uppsala University, Uppsala, Sweden.
authors: Ashish
authors: A
authors: K C
authors: International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Jennifer A
authors: JA
authors: Callaghan-Koru
authors: Save the Children, Washington, DC, USA and.
authors: Tanya
authors: T
authors: Guenther
authors: Save the Children, Washington, DC, USA and.
authors: Debora
authors: D
authors: Sitrin
authors: Save the Children, Washington, DC, USA and.
authors: Uzma
authors: U
authors: Syed
authors: Society of Public Health Physician.
authors: Yasho V
authors: YV
authors: Pradhan
authors: Save the Children, Washington, DC, USA and.
authors: Neena
authors: N
authors: Khadka
authors: International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Rashed
authors: R
authors: Shah
authors: International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Abdullah H
authors: AH
authors: Baqui
mesh_terms: D000293:Adolescent; D000328:Adult; D001942:Breast Feeding / Q000706:statistics & numerical data; D003153:Community Health Services / Q000706:statistics & numerical data; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D000068104:Infant Health / Q000706:statistics & numerical data*; D007226:Infant Mortality; D007231:Infant, Newborn; D008427:Maternal Health Services; D008428:Maternal Mortality; D009390:Nepal; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Community-based interventions; equity; maternal care; newborn care