DAILY MONITOR UGANDA: In 2015, it was estimated that nearly 10 out of every 100 Ugandan children born alive do not live beyond their fifth birthday and in total, 39,000 new-borns die every … Read more about Launch of BCG study in Uganda
Background Randomised controlled trials can provide evidence relevant to assessing the equity impact of an intervention, but such information is often poorly reported. We describe a conceptual framework to identify health equity-relevant randomised trials with the aim of improving the design and reporting of such trials.
Methods An interdisciplinary and international research team engaged in an iterative consensus building process to develop and refine the conceptual framework via face-to-face meetings, teleconferences and email correspondence, including findings from a validation exercise whereby two independent reviewers used the emerging framework to classify a sample of randomised trials.
Results A randomised trial can usefully be classified as ‘health equity relevant’ if it assesses the effects of an intervention on the health or its determinants of either individuals or a population who experience ill health due to disadvantage defined across one or more social determinants of health. Health equity-relevant randomised trials can either exclusively focus on a single population or collect data potentially useful for assessing differential effects of the intervention across multiple populations experiencing different levels or types of social disadvantage. Trials that are not classified as ‘health equity relevant’ may nevertheless provide information that is indirectly relevant to assessing equity impact, including information about individual level variation unrelated to social disadvantage and potentially useful in secondary modelling studies.
Conclusion The conceptual framework may be used to design and report randomised trials. The framework could also be used for other study designs to contribute to the evidence base for improved health equity.
randomized controlled trials
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Objective To examine gender differences in infant survival on the first day of life, in the first week of life, and in the neonatal and post-neonatal periods by socio-demographic and economic variables.
Design Secondary data analysis was performed on data from a cluster randomised trial on the effect of implementation of the Integrated Management of Neonatal and Childhood Illness programme, India.
Settings The study setting was Palwal and Faridabad, districts of Haryana, a state in North India.
Measures Multiple logistic regression models taking the cluster design into account were used to estimate gender differences in mortality in different periods of infancy.
Results A total of 60 480 infants were included in these analyses. Of 4060 infant deaths, 2054 were female (7.2% of all females born) and 2006 were male (6.3% of all males born). The death rate was significantly higher in females in the post-neonatal period but not during the neonatal period. The odds of death at 29–180 days and at 181–365 days were 1.4 (95% CI 1.3 to 1.6) and 1.7 (95% CI: 1.4 to 2.0) higher in females compared with males, respectively. This increase was seen across all socio-demographic and economic strata.
Conclusion Gender differences during the post-neonatal period are a major threat to the survival and health of female infants in India. Programmes need to identify measures that can specifically reduce female mortality.
BACKGROUND: There is no consensus on optimal Vitamin D status. The objective of this study was to estimate the extent to which vitamin D status predicts illness duration and treatment failure in children with severe pneumonia by using different cut-offs for vitamin D concentration.
METHODS: We measured the plasma-concentration of 25(OH)D in 568 children hospitalized with WHO-defined severe pneumonia. The associations between vitamin D status, using the most frequently used cut-offs of vitamin D insufficiency (25(OH)D <50 and <75 nmol/l) and risk of treatment failure and time until recovery were analysed in multiple logistic regression and Cox proportional hazards models, respectively.
RESULTS: Of the 568 children, 322 (56.7%) had plasma-25(OH)D ≥75 nmol/l, 179 (31.5%) 50-74.9 nmol/l and 67 (%) <50 nmol/l. Plasma-25(OH)D <50 nmol/l was associated with increased risk of treatment failure and longer time until recovery.
CONCLUSION: Our findings indicate that low vitamin D status (25(OH)D <50 nmol/l) is an independent risk factor for treatment failure and delayed recovery of severe lower respiratory infections in children.
TRIAL REGISTRATION: NCT00252304.Pediatric Research accepted article preview online, 05 July 2017. doi:10.1038/pr.2017.71.