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

Cesar G. Victora, Aluisio J D Barros, Henrik Axelson, Zulfiqar A. Bhutta, Mickey Chopra, Giovanny V A França, Kate Kerber, Betty R. Kirkwood, Holly Newby, Carine Ronsmans, J. Ties Boerma

Research output: Contribution to journalArticle

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. Funding Bill &Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK.

Original languageEnglish (US)
Pages (from-to)1149-1156
Number of pages8
JournalThe Lancet
Volume380
Issue number9848
DOIs
StatePublished - Sep 2012
Externally publishedYes

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Insecticide-Treated Bednets
Measles
Vaccination
Parturition
United Nations
Norway
Sweden
Canada
Brazil
Mothers
Demography
Surveys and Questionnaires
Child Health
Maternal Health
Health
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Victora, C. G., Barros, A. J. D., Axelson, H., Bhutta, Z. A., Chopra, M., França, G. V. A., ... Boerma, J. T. (2012). How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: An analysis of national surveys. The Lancet, 380(9848), 1149-1156. https://doi.org/10.1016/S0140-6736(12)61427-5

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; Bhutta, Zulfiqar A.; Chopra, Mickey; França, Giovanny V A; Kerber, Kate; Kirkwood, Betty R.; Newby, Holly; Ronsmans, Carine; Boerma, J. Ties.

In: The Lancet, Vol. 380, No. 9848, 09.2012, p. 1149-1156.

Research output: Contribution to journalArticle

Victora, CG, Barros, AJD, Axelson, H, Bhutta, ZA, Chopra, M, França, GVA, Kerber, K, Kirkwood, BR, Newby, H, Ronsmans, C & Boerma, JT 2012, 'How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: An analysis of national surveys', The Lancet, vol. 380, no. 9848, pp. 1149-1156. https://doi.org/10.1016/S0140-6736(12)61427-5
Victora, Cesar G. ; Barros, Aluisio J D ; Axelson, Henrik ; Bhutta, Zulfiqar A. ; Chopra, Mickey ; França, Giovanny V A ; Kerber, Kate ; Kirkwood, Betty R. ; Newby, Holly ; Ronsmans, Carine ; Boerma, J. Ties. / How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries : An analysis of national surveys. In: The Lancet. 2012 ; Vol. 380, No. 9848. pp. 1149-1156.
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N2 - 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. Funding Bill &Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK.

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