Effectiveness of Multiple-Strategy Community Intervention in Reducing Geographical, Socioeconomic and Gender Based Inequalities in Maternal and Child Health Outcomes in Haryana, India

Madhu Gupta; Federica Angeli; Hans Bosma; Monica Rana; Shankar Prinja; Rajesh Kumar; Onno C P van Schayck

doi:10.1371/journal.pone.0150537

Effectiveness of Multiple-Strategy Community Intervention in Reducing Geographical, Socioeconomic and Gender Based Inequalities in Maternal and Child Health Outcomes in Haryana, India

PLoS One. 2016 Mar 22;11(3):e0150537. doi: 10.1371/journal.pone.0150537. eCollection 2016.

Authors

Madhu Gupta¹, Federica Angeli², Hans Bosma³, Monica Rana¹, Shankar Prinja¹, Rajesh Kumar¹, Onno C P van Schayck⁴

Affiliations

¹ Department of Community Medicine, School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
² Department of Health Services Research, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
³ Department of Social Medicine, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.
⁴ Department of Family Practice, School of Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.

Abstract

Objective: The implemented multiple-strategy community intervention National Rural Health Mission (NRHM) between 2005 and 2012 aimed to reduce maternal and child health (MCH) inequalities across geographical, socioeconomic and gender categories in India. The objective of this study is to quantify the extent of reduction in these inequalities pre- and post-NRHM in Haryana, North India.

Methods: Data of district-level household surveys (DLHS) held before (2002-04), during (2007-08), and after (2012-13) the implementation of NRHM has been used. Geographical, socioeconomic and gender inequalities in maternal and child health were assessed by estimating the absolute differences in MCH indicators between urban and rural areas, between the most advantaged and least advantaged socioeconomic groups and between male and female children. Logistic regression analyses were done to observe significant differences in these inequalities between 2005 and 2012.

Results: There were significant improvements in all MCH indicators (p<0.05). The geographical and socioeconomic differences between urban and rural areas, and between rich and poor were significantly (p<0.05) reduced for pregnant women who had an institutional delivery (geographical difference declining from 22% to 7.6%; socioeconomic from 48.2% to 13%), post-natal care within 2 weeks of delivery (2.8% to 1.5%; 30.3% to 7%); and for children with full vaccination (10% to 3.5%, 48.3% to 14%) and who received oral rehydration solution (ORS) for diarrhea (11% to -2.2%; 41% to 5%). Inequalities between male and female children were significantly (p<0.05) reversed for full immunization (5.7% to -0.6%) and BCG immunization (1.9 to -0.9 points), and a significant (p<0.05) decrease was observed for oral polio vaccine (4.0% to 0%) and measles vaccine (4.2% to 0.1%).

Conclusions: The implemented multiple-strategy community intervention National Rural Health Mission (NRHM) between 2005 and 2012 might have resulted in significant reductions in geographical, socioeconomic and gender inequalities in MCH in Haryana, as causal relationships cannot be established with descriptive research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Child
Child Health / statistics & numerical data*
Family
Female
Gender Identity
Geography / statistics & numerical data
Humans
Immunization / statistics & numerical data
India
Infant
Male
Measles Vaccine / immunology
Middle Aged
Poliovirus Vaccine, Oral / immunology
Residence Characteristics / statistics & numerical data*
Rural Population / statistics & numerical data*
Socioeconomic Factors
Vaccination / statistics & numerical data

Substances

Measles Vaccine
Poliovirus Vaccine, Oral

Grants and funding

The study was funded by the National Rural Health Mission, Haryana. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.