Advanced

How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys

Victora, Cesar G.; Barros, Aluisio J. D.; Axelson, Henrik LU ; Bhutta, Zulfiqar A.; Chopra, Mickey; Franca, Giovanny V. A.; Kerber, Kate; Kirkwood, Betty R.; Newby, Holly and Ronsmans, Carine, et al. (2012) In The Lancet 380(9848). p.1149-1156
Abstract
Background Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children. Methods We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We... (More)
Background Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children. Methods We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels. Findings We included 35 countries with surveys done an average of 9.1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles. Interpretation Equity should be accounted for when planning the scaling up of interventions and assessing national progress. (Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Lancet
volume
380
issue
9848
pages
1149 - 1156
publisher
Elsevier Limited
external identifiers
  • wos:000309255900032
  • scopus:84866743022
ISSN
1474-547X
DOI
10.1016/S0140-6736(12)61427-5
language
English
LU publication?
yes
id
03fd6837-18bd-4700-8505-d13126858c64 (old id 3190094)
date added to LUP
2012-12-03 07:10:43
date last changed
2017-11-12 03:16:15
@article{03fd6837-18bd-4700-8505-d13126858c64,
  abstract     = {Background Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children. Methods We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels. Findings We included 35 countries with surveys done an average of 9.1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles. Interpretation Equity should be accounted for when planning the scaling up of interventions and assessing national progress.},
  author       = {Victora, Cesar G. and Barros, Aluisio J. D. and Axelson, Henrik and Bhutta, Zulfiqar A. and Chopra, Mickey and Franca, Giovanny V. A. and Kerber, Kate and Kirkwood, Betty R. and Newby, Holly and Ronsmans, Carine and Boerma, J. Ties},
  issn         = {1474-547X},
  language     = {eng},
  number       = {9848},
  pages        = {1149--1156},
  publisher    = {Elsevier Limited},
  series       = {The Lancet},
  title        = {How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys},
  url          = {http://dx.doi.org/10.1016/S0140-6736(12)61427-5},
  volume       = {380},
  year         = {2012},
}