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

Tarun Shankar Choudhary,Sarmila Mazumder,Øystein Ariansen Haaland,Jose Martines,Sunita Taneja,Nita Bhandari,Rajiv Bahl,Kjell Arne Johansson,Maharaj Kishan Bhan,Halvor Sommerfelt,Ole F Norheim

doi:10.1186/s12939-021-01605-0

Abstract

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.

Highlights

Kangaroo mother care (KMC) can substantially enhance overall survival of low birthweight babies
In a recent Randomized controlled trials (RCTs) in Haryana, India, we found that active promotion of community-initiated kangaroo mother care for infants weighing 1500 to 2250 g within 72 h of being born reduced their mortality until 180 days of life by 25% [11]
We explored the impact of community initiated KMC (ciKMC) on the distribution of improvements in survival across wealth status, maternal literacy, caste, religion, and infant sex

Summary

Introduction

Kangaroo 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). Health inequality refers to differences in the distribution of health status across population groups. When these differences are preventable and unjust across socially relevant groupings, it leads to health inequity [1]. Interest is shifting from only describing social determinants of health to understanding how these inequities can be addressed using programmatic and policy interventions [3]. Randomized controlled trials (RCTs) typically report average efficacy, and there is a lack of highquality RCTs describing the impact of interventions on inequities between individuals or groups.

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