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

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

Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. Research in 35 countries assessed 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.

Coverage was assessed in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. 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. Coverage data was stratified according to asset-based wealth quintiles, and relative and absolute indices of inequality were calculated. Correlation analyses was adjusted for time between surveys and baseline coverage levels.

35 countries with surveys done an average of 9·1 years apart were included in the analysis. Pro-rich inequalities were very prevalent. Observations included 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.

Equity should be accounted for when planning the scaling up of interventions and assessing national progress.

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