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Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries

Barros, Aluisio J. D.; Ronsmans, Carine; Axelson, Henrik LU ; Loaiza, Edilberto; Bertoldi, Andrea D.; Franca, Giovanny V. A.; Bryce, Jennifer; Boerma, J. Ties and Victora, Cesar G. (2012) In The Lancet 379(9822). p.1225-1233
Abstract
Background Countdown to 2015 tracks progress towards achievement of Millennium Development Goals (MDGs) 4 and 5, with particular emphasis on within-country inequalities. We assessed how inequalities in maternal, newborn, and child health interventions vary by intervention and country. Methods We reanalysed data for 12 maternal, newborn, and child health interventions from national surveys done in 54 Countdown countries between Jan 1, 2000, and Dec 31, 2008. We calculated coverage indicators for interventions according to standard definitions, and stratified them by wealth quintiles on the basis of asset indices. We assessed inequalities with two summary indices for absolute inequality and two for relative inequality. Findings Skilled birth... (More)
Background Countdown to 2015 tracks progress towards achievement of Millennium Development Goals (MDGs) 4 and 5, with particular emphasis on within-country inequalities. We assessed how inequalities in maternal, newborn, and child health interventions vary by intervention and country. Methods We reanalysed data for 12 maternal, newborn, and child health interventions from national surveys done in 54 Countdown countries between Jan 1, 2000, and Dec 31, 2008. We calculated coverage indicators for interventions according to standard definitions, and stratified them by wealth quintiles on the basis of asset indices. We assessed inequalities with two summary indices for absolute inequality and two for relative inequality. Findings Skilled birth attendant coverage was the least equitable intervention, according to all four summary indices, followed by four or more antenatal care visits. The most equitable intervention was early initation of breastfeeding. Chad, Nigeria, Somalia, Ethiopia, Laos, and Niger were the most inequitable countries for the interventions examined, followed by Madagascar, Pakistan, and India. The most equitable countries were Uzbekistan and Kyrgyzstan. Community-based interventions were more equally distributed than those delivered in health facilities. For all interventions, variability in coverage between countries was larger for the poorest than for the richest individuals. Interpretation We noted substantial variations in coverage levels between interventions and countries. The most inequitable interventions should receive attention to ensure that all social groups are reached. Interventions delivered in health facilities need specific strategies to enable the countries' poorest individuals to be reached. The most inequitable countries need additional efforts to reduce the gap between the poorest individuals and those who are more affluent. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Lancet
volume
379
issue
9822
pages
1225 - 1233
publisher
Elsevier Limited
external identifiers
  • wos:000302230400035
  • scopus:84859193630
ISSN
1474-547X
language
English
LU publication?
yes
id
db506993-213a-4567-90ca-0b34c3f01448 (old id 2494780)
date added to LUP
2012-05-07 14:22:45
date last changed
2017-11-19 03:21:56
@article{db506993-213a-4567-90ca-0b34c3f01448,
  abstract     = {Background Countdown to 2015 tracks progress towards achievement of Millennium Development Goals (MDGs) 4 and 5, with particular emphasis on within-country inequalities. We assessed how inequalities in maternal, newborn, and child health interventions vary by intervention and country. Methods We reanalysed data for 12 maternal, newborn, and child health interventions from national surveys done in 54 Countdown countries between Jan 1, 2000, and Dec 31, 2008. We calculated coverage indicators for interventions according to standard definitions, and stratified them by wealth quintiles on the basis of asset indices. We assessed inequalities with two summary indices for absolute inequality and two for relative inequality. Findings Skilled birth attendant coverage was the least equitable intervention, according to all four summary indices, followed by four or more antenatal care visits. The most equitable intervention was early initation of breastfeeding. Chad, Nigeria, Somalia, Ethiopia, Laos, and Niger were the most inequitable countries for the interventions examined, followed by Madagascar, Pakistan, and India. The most equitable countries were Uzbekistan and Kyrgyzstan. Community-based interventions were more equally distributed than those delivered in health facilities. For all interventions, variability in coverage between countries was larger for the poorest than for the richest individuals. Interpretation We noted substantial variations in coverage levels between interventions and countries. The most inequitable interventions should receive attention to ensure that all social groups are reached. Interventions delivered in health facilities need specific strategies to enable the countries' poorest individuals to be reached. The most inequitable countries need additional efforts to reduce the gap between the poorest individuals and those who are more affluent.},
  author       = {Barros, Aluisio J. D. and Ronsmans, Carine and Axelson, Henrik and Loaiza, Edilberto and Bertoldi, Andrea D. and Franca, Giovanny V. A. and Bryce, Jennifer and Boerma, J. Ties and Victora, Cesar G.},
  issn         = {1474-547X},
  language     = {eng},
  number       = {9822},
  pages        = {1225--1233},
  publisher    = {Elsevier Limited},
  series       = {The Lancet},
  title        = {Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries},
  volume       = {379},
  year         = {2012},
}