***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This paper assessed  gender bias  within  hospitalisation rates to ascertain whether differential care-seeking practice s significantly contribute to excess female mortality . It then examined the impact of socio-economic factors , particularly maternal education and economic status , on gender bias . The results find both the clear and significant impact of gender on hospitalisation rates , as well as the simultaneous inability of rising education and economic status to alleviate this bias . A secondary analysis was conducted within a uniquely large and ongoing r and omised control trial that sought to measure the impact of Zinc supplementation on  hospitalisations and deaths in low-income communities in New Delhi , India . During the course of the study , 85,633 children were enrolled and monitored over one year of follow-up . Of the 430 deaths that occurred , 230 were female ( 0.57 % of total females ) , while 200 were male ( 0.43 % of all males ) . Despite this higher mortality amongst females ( p<0.02 ) , girls were hospitalised far less frequently than boys . Of the 4418 children who were hospitalised at least once , 2854 ( 64.6 % ) were males and only 1564 ( 35.4 % ) were females , indicating a significantly lower rate of care-seeking for females ( p<0.00 ) . Curiously , our results show that gender bias is highest amongst highly educated mothers , and decreases steadily for children of mothers with a middle school education , a primary school education , and is lowest amongst mothers with no formal education . Put differently , female children of mothers with no formal education were significantly more likely to be hospitalised than children of mothers with several years of formal education , even after adjusting for all other factors . Economic status was not found to affect the association of gender and hospitalisation , though overall odds of hospitalisation rose with increasing economic status . Paternal education was found not to be significantly related to hospitalisation Background Despite the increased burden of preterm birth and its complications , the dearth of care seeking data for preterm newborns remains a significant knowledge gap . Among preterm babies in rural Bangladesh , we examined : 1 ) determinants and patterns of care seeking , and 2 ) risk analysis for care-seeking from qualified and unqualified providers . Method Trained community health workers collected data prospect ively from 27,460 mother-liveborn baby pairs , including 6,090 preterm babies , between June 2007 and September 2009 . Statistical analyses included binomial and multinomial logistic regressions . Results Only one-fifth ( 19.7 % ) of preterm newborns were taken to seek either preventive or curative health care . Among care-seeker preterm newborns , preferred providers included homeopathic practitioners ( 50.0 % ) , and less than a third ( 30.9 % ) sought care from qualified providers . Care-seeking from either unqualified or qualified providers was significantly lower for female preterm babies , compared to male babies [ Relative Risk Ratio ( RRR ) for unqualified care : 0.68 ; 95 % Confidence Interval ( CI ) : 0.58 , 0.80 ; RRR for qualified care : 0.52 ; 95 % CI : 0.41 , 0.66 ] . Among preterm babies , care-seeking was significantly higher among caregivers who recognized symptoms of illness [ RR : 2.14 ; 95 % CI : 1.93 , 2.38 ] or signs of local infection ( RR : 2.53 ; 95 % CI : 2.23 , 2.87 ) , had a history of child death [ RR : 1.21 ; 95 % CI : 1.07 , 1.37 ] , any antenatal care ( ANC ) visit [ RR : 1.41 ; 95 % CI : 1.25 , 1.59 ] . Birth preparedness ( RRR : 1.24 ; 95 % CI : 1.09 , 1.68 ) and any ANC visit ( RRR : 1.73 ; 95 % CI : 1.50 , 2.49 ) were also associated with increased likelihood of care seeking for preterm babies from qualified providers . Conclusion To improve care seeking practice s for preterm babies and referral of sick newborns to qualified providers/facilities , we recommend : 1 ) involving community-preferred health care providers in community-based health education and awareness raising programs ; 2 ) integrating postnatal care seeking messages into antenatal counselling ; and 3 ) further research on care seeking practice s for preterm babies Although gender-based health disparities are prevalent in India , very little data are available on care-seeking patterns for newborns . In total , 255 mothers were prospect ively interviewed about their perceptions and action surrounding the health of their newborns in rural Uttar Pradesh , India .  Perception of illness was significantly lower in incidence ( adjusted odds ratio=0.56 , 95 % confidence interval 0.33 - 0.94 ) among households with female versus male newborns . While the overall use of healthcare providers was similar across gender , the average expenditure for healthcare during the neonatal period was nearly four-fold higher in households with males ( Rs 243.3±537.2 ) compared to females ( Rs 65.7±100.7 ) ( p=0.07 ) . Households with female newborns used cheaper public care providers whereas those with males preferred to use private unqualified providers perceived to deliver more satisfactory care . These results suggest that , during the neonatal period , care-seeking for girls is neglected compared to boys , laying a foundation for programmes and further research to address gender differences in neonatal health in India BACKGROUND Majority of the neonates in developing countries are born and cared for in rural homes but the available information is mostly hospital based . OBJECTIVES To estimate : ( i ) the incidence of various neonatal morbidities and associated case fatality in home-cared rural neonates , ( ii ) proportion of neonates with indications for health care , and ( iii ) the proportion who actually receive it . DESIGN Prospect i ve observational study . SETTING Rural homes . METHODS Neonates in 39 study villages in the Gadchiroli district ( Maharashtra , India ) were observed during one year ( 1995 - 96 ) by 39 trained female village health workers at birth and during neonatal period ( 0 - 28 days ) by making eight home visits . A physician checked the data and the morbidities were diagnosed by a computer program . Vital statistics in these villages was independently collected . RESULTS Out of 1016 live births , 95 % occurred at home and 763 ( 75&% ) neonates were observed . The agreement between observations by health workers and physician was 92 % . Total 48.2 & neonates suffered high risk morbidities ( associated case fatality > 10 % ) , 72.2 % suffered low risk morbidities , and 17.9 % gained inadequate weight ( less than 300 g ) . Seventeen percent neonates developed clinical picture suggestive of sepsis . Though 54.4 % neonates had indications for health care and 38 out of total 40 neonatal deaths occurred in these , only 2.6 % received medical attention . The neonatal mortality rate was 52.4/1000 live births . CONCLUSION Nearly half of the neonates in rural homes developed high risk morbidities ten times the neonatal morbidity rate and needed health care but practically none received it . The magnitude of care gap suggests an urgent need for developing home-based neonatal care to reduce neonatal morbidities and Background Studies in South Asia have documented increased risk of neonatal mortality among girls , despite evidence of a biological survival advantage . Associations between gender preference and mortality are cited as reasons for excess mortality among girls . This has not , however , been tested in statistical models . Methods A secondary analysis of data from a population -based r and omised controlled trial of newborn infection prevention conducted in rural southern Nepal was used to estimate sex differences in early and late neonatal mortality  , with girls as the reference group . The analysis investigated which underlying biological factors ( immutable factors specific to the newborn or his/her mother ) and environmental factors ( mutable external factors ) might explain observed sex differences in mortality . Results Neonatal mortality was comparable by sex ( Ref = girls ; OR 1.06 , 95 % CI 0.92 to 1.22 ) . When stratified by neonatal period , boys were at 20 % ( OR 1.20 , 95 % CI 1.02 % to 1.42 % ) greater risk of early and girls at 43 % ( OR 0.70 , 95 % CI 0.51 % to 0.94 % ) greater risk of late neonatal mortality . Biological factors , primarily respiratory depression and unconsciousness at birth , explained excess early neonatal mortality among boys . Increased late neonatal mortality among girls was explained by a three-way environmental interaction between ethnicity , sex and prior sibling composition ( categorised as primiparous newborns , infants born to families with prior living boys or boys and girls , and infants born to families with only prior living girls ) . Conclusions Risk of neonatal mortality inverted between the early and late neonatal periods . Excess risk of early neonatal death among boys was consistent with biological expectations . Excess risk for late neonatal death among girls was not explained by overarching gender preference or preferential care-seeking for boys as hypothesised , but was driven by increased risk among Madeshi girls born to families with only prior girls Objectives Neonatal deaths  account for 45 % of all under-five deaths globally and 60 % in Bangladesh . This study aim ed to investigate the most common symptoms and complications in neonates , care-seeking practice s of the mothers for their sick neonates , and factors associated with the care-seeking practice s. Methods This cross-sectional study analysed data from an Endline Household Survey ( as part of an evaluation of a paired cluster-r and omised controlled trial study in 14 rural sub-districts in Bangladesh ) of 2,931 women who gave birth recently . Descriptive analysis and logistic regressions were conducted to identify the care-seeking practice s of mothers of sick neonates and the factors associated with the care-seeking from trained providers . Results Of the 2868 neonates , 886 ( 30.9 % ) were reported ill during first 28 days after birth . For those with reported symptoms , 748 ( 84.4 % ) of their mothers sought care . Of those who sought care , 65.2 % sought care from untrained providers . Multiple logistic regression analysis showed significantly higher odds of care-seeking from trained providers when neonates had 3 or more concurrent symptoms ( OR : 1.82 ; 95 % CI : 1.07–3.08 ) ; when mothers perceived their neonates ’ symptoms as severe ( OR : 4.08 ; 95 % CI : 2.92–5.70 ) ; when mothers received skilled care during pregnancy ( OR : 1.95 ; 95 % CI : 1.34–2.84 ) ; and when mothers had their delivery in a facility ( OR : 3.50 ; 95 % CI : 2.18–5.62 ) . Mothers who delivered their babies at a facility , 43.1 % of them sought care for their sick neonates at the same type of public hospital and 34.9 % from same type of private hospitals where their deliveries took place . Conclusion Skilled care for mothers during pregnancy and delivery , and mothers ’ perceptions of the severity of symptoms are the key associated factors of care-seeking for sick neonates from trained providers . Interventions should be tailored to increase care from trained providers during pregnancy and delivery at facilities to improve care-seeking for neonates from trained providers and for the survival of neonates 
    Output:
    
Low quality evidence across several South Asian countries suggests that care-seeking rates for female neonates are lower than males , especially in households with older female children .
Parents are more likely to pay more , and seek care from providers perceived as higher quality , for males than females .
Evidence on drivers of these care-seeking behaviours is limited .
Conclusion Higher mortality observed among female neonates in South Asia may be partly explained by differences in care-seeking behaviour , though good quality evidence on drivers for this is lacking .