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.
Highlights
Achieving health equity is a major challenge for policy makers and health care planners around the globe [1] as well as a major challenge for the coming post-MDG agenda [2,3]
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
Over the entire study period no significant effect of the intervention could be seen, adjusted for household economic status, maternal ethnicity and education
Summary
Achieving health equity is a major challenge for policy makers and health care planners around the globe [1] as well as a major challenge for the coming post-MDG agenda [2,3]. Neonatal survival in a global context has just recently started to improve after a long period of stagnant development [8,9]. Even if there is still a long way to go before the large amount of preventable deaths in the neonatal period has been eliminated, the field of implementation science is growing, evaluating methods to translate evidence-based knowledge into practice [10]. To 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.
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