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Background In Bangladesh, India and Nepal, neonatal outcomes of poor infants are considerably worse than those of better-off infants. Understanding how these inequalities vary by country and place of delivery (home or facility) will allow targeting of interventions to those who need them most. We describe socio-economic inequalities in newborn care in rural areas of Bangladesh, Nepal and India for all deliveries and by place of delivery. Methods We used data from surveillance sites in Bangladesh, India and from Makwanpur and Dhanusha districts in Nepal, covering periods from 2001 to 2011. We used literacy (ability to read a short text) as indicator of socioeconomic status. We developed a composite score of nine newborn care practices (score range 0–9 indicating infants received no newborn care to all nine newborn care practices). We modeled the effect of literacy and place of delivery on the newborn care score and on individual practices. Results In all study sites (60,078 deliveries in total), use of facility delivery was higher among literate mothers. In all sites, inequalities in newborn care were observed: the difference in new born care between literate and illiterate ranged 0.35–0.80. The effect of literacy on the newborn care score reduced after adjusting for place of delivery (range score difference literate-illiterate: 0.21–0.43). Conclusion Socioeconomic inequalities in facility care greatly contribute to inequalities in newborn care. Improving newborn care during home deliveries and improving access to facility care are a priority for addressing inequalities in newborn care and newborn mortality. Electronic supplementary material The online version of this article (10.1186/s12939-018-0834-9) contains supplementary material, which is available to authorized users.

A quarter of the world's neonatal deaths and 15% of maternal deaths happen in India. Few community-based strategies to improve maternal and newborn health have been tested through the country's government-approved Accredited Social Health Activists (ASHAs). We aimed to test the effect of participatory women's groups facilitated by ASHAs on birth outcomes, including neonatal mortality.In this cluster-randomised controlled trial of a community intervention to improve maternal and newborn health, we randomly assigned (1:1) geographical clusters in rural Jharkhand and Odisha, eastern India to intervention (participatory women's groups) or control (no women's groups). Study participants were women of reproductive age (15-49 years) who gave birth between Sept 1, 2009, and Dec 31, 2012. In the intervention group, ASHAs supported women's groups through a participatory learning and action meeting cycle. Groups discussed and prioritised maternal and newborn health problems, identified strategies to address them, implemented the strategies, and assessed their progress. We identified births, stillbirths, and neonatal deaths, and interviewed mothers 6 weeks after delivery. The primary outcome was neonatal mortality over a 2 year follow up. Analyses were by intention to treat. This trial is registered with ISRCTN, number ISRCTN31567106.Between September, 2009, and December, 2012, we randomly assigned 30 clusters (estimated population 156 519) to intervention (15 clusters, estimated population n=82 702) or control (15 clusters, n=73 817). During the follow-up period (Jan 1, 2011, to Dec 31, 2012), we identified 3700 births in the intervention group and 3519 in the control group. One intervention cluster was lost to follow up. The neonatal mortality rate during this period was 30 per 1000 livebirths in the intervention group and 44 per 1000 livebirths in the control group (odds ratio [OR] 0.69, 95% CI 0·53-0·89).ASHAs can successfully reduce neonatal mortality through participatory meetings with women's groups. This is a scalable community-based approach to improving neonatal survival in rural, underserved areas of India.Big Lottery Fund (UK).

Background Child stunting (low height-for-age) is a marker of chronic undernutrition and predicts children’s subsequent physical and cognitive development. Around one third of the world’s stunted children live in India. Our study aims to assess the impact, cost-effectiveness, and scalability of a community intervention with a government-proposed community-based worker to improve growth in children under two in rural India. Methods The study is a cluster randomised controlled trial in two rural districts of Jharkhand and Odisha (eastern India). The intervention tested involves a community-based worker carrying out two activities: (a) one home visit to all pregnant women in the third trimester, followed by subsequent monthly home visits to all infants aged 0–24 months to support appropriate feeding, infection control, and care-giving; (b) a monthly women’s group meeting using participatory learning and action to catalyse individual and community action for maternal and child health and nutrition. Both intervention and control clusters also receive an intervention to strengthen Village Health Sanitation and Nutrition Committees. The unit of randomisation is a purposively selected cluster of approximately 1000 population. A total of 120 geographical clusters covering an estimated population of 121,531 were randomised to two trial arms: 60 clusters in the intervention arm receive home visits, group meetings, and support to Village Health Sanitation and Nutrition Committees; 60 clusters in the control arm receive support to Committees only. The study participants are pregnant women identified in the third trimester of pregnancy and their children (n = 2520). Mothers and their children are followed up at seven time points: during pregnancy, within 72 hours of delivery, and at 3, 6, 9, 12 and 18 months after birth. The trial’s primary outcome is children’s mean length-for-age Z scores at 18 months. Secondary outcomes include wasting and underweight at all time points, birth weight, growth velocity, feeding, infection control, and care-giving practices. Additional qualitative and quantitative data are collected for process and economic evaluations. Discussion This trial will contribute to evidence on effective strategies to improve children's growth in India. Trial registration ISRCTN register 51505201; Clinical Trials Registry of India number 2014/06/004664. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1655-z) contains supplementary material, which is available to authorized users.

Background Delivery of essential newborn care is key to reducing neonatal mortality rates, yet coverage of protective birth practices remains incomplete and variable, with or without skilled attendance. Evidence of changes over time in newborn care provision, disaggregated by care practice and delivery type, can be used by policymakers to review efforts to reduce mortality. We examine such trends in four areas using control arm trial data. Methods and Findings We analysed data from the control arms of cluster randomised controlled trials in Bangladesh (27 553 births), eastern India (8 939), Dhanusha, Nepal (15 344) and Makwanpur, Nepal (6 765) over the period 2001–2011. For each trial, we calculated the observed proportion of attended births and the coverage of WHO essential newborn care practices by year, adjusted for clustering and stratification. To explore factors contributing to the observed trends, we then analysed expected trends due only to observed shifts in birth attendance, accounted for stratification, delivery type and statistically significant interaction terms, and examined disaggregated trends in care practice coverage by delivery type. Attended births increased over the study periods in all areas from very low rates, reaching a maximum of only 30% of deliveries. Newborn care practice trends showed marked heterogeneity within and between areas. Adjustment for stratification, birth attendance and interaction revealed that care practices could change in opposite directions over time and/or between delivery types – e.g. in Bangladesh hygienic cord-cutting and skin-to-skin contact fell in attended deliveries but not home deliveries, whereas in India birth attendant hand-washing rose for institutional deliveries but fell for home deliveries. Conclusions Coverage of many essential newborn care practices is improving, albeit slowly and unevenly across sites and delivery type. Time trend analyses of birth patterns and essential newborn care practices can inform policy-makers about effective intervention strategies.

To determine whether a women's group intervention involving participatory learning and action has a sustainable and replicable effect on neonatal survival in rural, eastern India.From 2004 to 2011, births and neonatal deaths in 36 geographical clusters in Jharkhand and Odisha were monitored. Between 2005 and 2008, these clusters were part of a randomized controlled trial of how women's group meetings involving participatory learning and action influence maternal and neonatal health. Between 2008 and 2011, groups in the original intervention clusters (zone 1) continued to meet to discuss post-neonatal issues and new groups in the original control clusters (zone 2) met to discuss neonatal health. Logistic regression was used to examine neonatal mortality rates after 2008 in the two zones.Data on 41,191 births were analysed. In zone 1, the intervention's effect was sustained: the cluster-mean neonatal mortality rate was 34.2 per 1000 live births (95% confidence interval, CI: 28.3-40.0) between 2008 and 2011, compared with 41.3 per 1000 live births (95% CI: 35.4-47.1) between 2005 and 2008. The effect of the intervention was replicated in zone 2: the cluster-mean neonatal mortality rate decreased from 61.8 to 40.5 per 1000 live births between two periods: 2006-2008 and 2009-2011 (odds ratio: 0.69, 95% CI: 0.57-0.83). Hygiene during delivery, thermal care of the neonate and exclusive breastfeeding were important factors.The effect of participatory women's groups on neonatal survival in rural India, where neonatal mortality is high, was sustainable and replicable.Déterminer si un groupe féminin menant des activités d’apprentissage et des actions participatives a un effet durable et reproductible sur la survie néonatale dans l’Inde de l’Est rurale.De 2004 à 2011, les naissances et la mortalité néonatale ont été suivies dans 36 zones géographiques des États du Jharkhand et de l'Odisha. Entre 2005 et 2008, ces zones ont été intégrées dans un essai contrôlé randomisé portant sur l’influence sur la santé maternelle et néonatale des réunions de groupes féminins menant des activités d’apprentissage et des actions participatives. Entre 2008 et 2011, les groupes provenant des zones d’intervention d’origine (zone 1) se réunissaient toujours pour débattre des questions post-néonatales, et les nouveaux groupes provenant des zones de contrôle d’origine (zone 2) se sont réunis pour aborder le sujet de la santé néonatale. On a eu recours à la régression logistique pour analyser les taux de mortalité néonatale après 2008 dans ces deux zones.Les données de 41 191 naissances ont été analysées. Dans la zone 1, l’effet de l’intervention s’est révélé durable: le taux de mortalité néonatale moyen de la région a été de 34,2 pour 1 000 naissances vivantes (intervalle de confiance de 95%, IC: 28,3–40) entre 2008 et 2011, par rapport à 41,3 pour 1 000 naissances vivantes (IC de 95%: 35,4–47,1) entre 2005 et 2008. L’effet de l’intervention s’est reproduit dans la zone 2: le taux de mortalité néonatale moyen de la zone a baissé de 61,8 à 40,5 pour 1 000 naissances vivantes entre les deux périodes: 2006–2008 et 2009–2011 (rapport des cotes, RC: 0,69, IC de 95%: 0,57–0,83). L’hygiène pendant l’accouchement, le maintien de la température corporelle du nouveau-né et l’allaitement maternel exclusif ont été des facteurs importants.L’effet des groupes féminins participatifs sur la survie néonatale dans l’Inde rurale, où la mortalité néonatale est élevée, s’est révélé durable et reproductible.Determinar si las intervenciones con aprendizaje y acción participativos con grupos de mujeres tienen un efecto sostenible y reproducible en la supervivencia neonatal en las zonas rurales del este de India.Desde 2004 hasta 2011 se controlaron los nacimientos y muertes neonatales en 36 agrupaciones geográficas en Jharkhand y Odisha. Entre 2005 y 2008, esas agrupaciones formaron parte de un ensayo controlado aleatorio para averiguar cómo las reuniones de grupos de mujeres que incluyen un aprendizaje y acción participativos influyen en la salud materna y neonatal. Entre 2008 y 2011, los grupos en las agrupaciones originales de intervención (zona 1) siguieron reuniéndose para debatir sobre cuestiones posneonatales y otros grupos nuevos en las agrupaciones originales de control (zona 2) se reunieron para debatir sobre la salud neonatal. Se empleó una regresión logística para examinar las tasas de mortalidad neonatal en ambas zonas tras del año 2008.Se analizaron los datos de 41 191 nacimientos. En la zona 1, el efecto de la intervención fue prolongado: la tasa de mortalidad neonatal media en la agrupación fue de 34,2 por cada 1000 nacidos vivos (intervalo de confianza del 95%, IC: 28,3–40,0) entre 2008 y 2011, comparada con el 41,3 por cada 1000 nacidos vivos (IC del 95%: 35,4–47,1) entre los años 2005 y 2008. El efecto de la intervención se repitió en la zona 2: la tasa de mortalidad neonatal media descendió del 61,8 hasta el 40,5 por cada 1000 nacidos vivos entre dos periodos: 2006–2008 y 2009–2011 (cociente de probabilidades: 0,69, IC del 95%: 0,57–0,83). Algunos factores importantes fueron la higiene durante el parto, la atención térmica de los neonatos y la lactancia materna exclusiva.El efecto de los grupos participativos de mujeres sobre la supervivencia neonatal en las zonas rurales de India, donde la mortalidad neonatal es elevada, resultó sostenible y reproducible.تحديد ما إذا كان لتدخل جماعات المرأة الذي يتضمن التعلم والعمل على نحو تشاركي تأثير مستدام قابل للمماثلة على بقاء المواليد على قيد الحياة في المناطق الريفية شرق الهند.في الفترة من 2004 إلى 2011، تم رصد المواليد ووفيات المواليد في 36 مجموعة جغرافية في جاركند وأوديشا. وفي الفترة بين 2005 و2008، كانت هذه المجموعات جزءاً من تجربة عشوائية أجريت في بيئة خاضعة للمراقبة حول مدى تأثير اجتماعات جماعات المرأة التي تتضمن التعلم والعمل على تشاركي على صحة الأمومة والمواليد. وفي الفترة من 2008 إلى 2011، واصلت الجماعات في مجموعات التدخل الأصلية (المنطقة 1) اجتماعاتها لمناقشة القضايا المتعلقة بمرحلة ما بعد المواليد والتقت الجماعات الجديدة في مجموعات المراقبة الأصلية (المنطقة 2) لمناقشة صحة المواليد. وتم استخدام الارتداد اللوجيستي لدراسة معدلات وفيات المواليد بعد عام 2008 في المنطقتين.تم تحليل البيانات المعنية بالمواليد البالغ عددهم 41191 مولوداً. وفي المنطقة 1، تم الحفاظ على تأثير التدخل: بلغ معدل وفيات المواليد لمتوسط المجموعة 34.2 لكل 1000 مولود حي (فاصل الثقة 95 %، فاصل الثقة: من 28.3 إلى 40.0) في الفترة من 2008 إلى 2011، مقارنة بنسبة 41.3 لكل 1000 مولود حي (فاصل الثقة 95 %، فاصل الثقة: من 35.4 إلى 47.1) في الفترة من 2005 إلى 2008. وتم نسخ تأثير التدخل في المنطقة 2: وانخفض معدل وفيات المواليد لمتوسط المجموعة من 61.8 إلى 40.5 لكل 1000 مولود حي بين الفترتين: 2006-2008 و2009-2011 (نسبة الاحتمال: 0.69، فاصل الثقة 95 %، فاصل الثقة: من 0.57 إلى 0.83). وكان التصحيح أثناء الولادة والرعاية الحرارية للمواليد والرضاعة الطبيعية الخالصة عوامل مهمة.كان تأثير جماعات المرأة التشاركية على بقاء المواليد على قيد الحياة في المناطق الهندية الريفية، التي يرتفع بها معدل وفيات المواليد، مستداماً وقابلاً للمماثلة.确定涉及参与式学习和行动的妇女团体干预是否对印度东部的新生儿生存率有可持续和可重复的影响。从2004 年到2011 年，对贾坎德邦和奥里萨邦的36 个地理集群的分娩和新生儿死亡进行监测。在2005 年至2008 年之间，这些集群是随机对照试验的组成部分，这些试验研究涉及参与式学习和行动的妇女团体集会如何影响孕产妇和新生儿健康。在2008 年至2011 年间，原始干预集群的团体（区域1）继续集会，以讨论新生儿后期的问题；原始对照集群的新团体（区域2）集会，以讨论新生儿保健问题。使用逻辑回归查看在2008 年之后两个区域中新生儿的死亡率。分析了41191 例出生的数据。在区域1，干预效果保持：集群平均新生儿死亡率在2008 年至2011 年是每千活产34.2 例（95% 置信区间，CI：28.3–40.0），与之相比的是2005 至2008 年每千活产41.3 例（95% CI：35.4–47.1）。干预效果在区域2 得到重复：在两个期间，2006-2008 和2009-2011 年，集群平均新生儿死亡率从每千活产61.8 例降低至40.5 例（优势比：0.69，95% CI：0.57–0.83）。分娩时的卫生保健、新生儿体温护理和纯母乳喂养是重要因素。在新生儿死亡率高的印度农村地区，与新生儿生存相关的参与性妇女团体的效果是可持续和可重复的。Установить, оказывают ли мероприятия по проведению коллективного обучения и занятий в женской группе продолжительное и воспроизводимое влияние на неонатальную выживаемость в сельских районах восточной Индии.В 2004-2011 гг. проводился мониторинг рождаемости и неонатальной смертности в 36 географических кластерах в штатах Джаркханд и Орисса. В период с 2005 по 2008 гг. данные кластеры участвовали в рандомизированном контролируемом исследовании влияния собраний женских групп, включающих коллективное обучение и занятия, на охрану здоровья матери и ребенка. В период с 2008 по 2011 гг. группы в исходных кластерах проведения мероприятий (зона 1) продолжали проведение встреч для обсуждения постнеонатальных вопросов, а в новых группах исходных контрольных кластеров (зона 2) на встречах обсуждались вопросы неонатального здоровья. В обеих зонах использовалась логистическая регрессия для изучения уровней неонатальной смертности после 2008 года.Проведен анализ данных по 41 191 родам. В зоне 1 влияние проводимых мероприятий было продолжительным: средний уровень неонатальной смертности в кластере составил 34,2 на 1000 живорождений (95% доверительный интервал, ДИ: 28,3–40,0) в период с 2008 по 2011 гг., по сравнению с 41,3 на 1000 живорождений (95% ДИ: 35,4–47,1) в период с 2005 по 2008 гг. Аналогичное влияние проводимых мероприятий отмечено в зоне 2: средний уровень неонатальной смертности в кластере снизился с 61,8 до 40,5 на 1000 живорождений в обоих периодах: 2006-2008 гг. и 2009-2011 гг. (относительный риск: 0,69, 95% ДИ: 0,57-0,83). Важными факторами являлись соблюдение гигиены во время родоразрешения, тепловая защита новорожденных и исключительно грудное вскармливание.Влияние коллективных женских групп на неонатальную выживаемость в сельских районах Индии с высоким уровнем смертности являлось продолжительным и воспроизводимым.