Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries
Abstract Background Persistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based...
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| Format: | Article |
| Language: | English |
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BMC
2023-10-01
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| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12939-023-02015-0 |
| _version_ | 1827635149434519552 |
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| author | Anteneh Asefa Samson Gebremedhin Tiara Marthias Herfina Nababan Aliki Christou Aline Semaan Aduragbemi Banke-Thomas Hanani Tabana Fadhlun M. Alwy Al-beity Jean-Paul Dossou Keneni Gutema Thérèse Delvaux Catherine Birabwa Mardieh Dennis Fassou Mathias Grovogui Barbara McPake Lenka Beňová |
| author_facet | Anteneh Asefa Samson Gebremedhin Tiara Marthias Herfina Nababan Aliki Christou Aline Semaan Aduragbemi Banke-Thomas Hanani Tabana Fadhlun M. Alwy Al-beity Jean-Paul Dossou Keneni Gutema Thérèse Delvaux Catherine Birabwa Mardieh Dennis Fassou Mathias Grovogui Barbara McPake Lenka Beňová |
| author_sort | Anteneh Asefa |
| collection | DOAJ |
| description | Abstract Background Persistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based inequalities in coverage of maternal continuum of care in 16 SSA countries with the objective of informing targeted policies to ensure maternal health equity in the region. Methods We conducted a secondary analysis of Demographic and Health Survey (DHS) data from 16 SSA countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia). A total of 133,709 women aged 15-49 years who reported a live birth in the five years preceding the survey were included. We defined and measured completion of maternal continuum of care as having had at least one antenatal care (ANC) visit, birth in a health facility, and postnatal care (PNC) by a skilled provider within two days of birth. We used concentration index analysis to measure wealth-based inequality in maternal continuum of care and conducted decomposition analysis to estimate the contributions of sociodemographic and obstetric factors to the observed inequality. Results The percentage of women who had 1) at least one ANC visit was lowest in Ethiopia (62.3%) and highest in Burundi (99.2%), 2) birth in a health facility was less than 50% in Ethiopia and Nigeria, and 3) PNC within two days was less than 50% in eight countries (Angola, Burundi, Ethiopia, Gambia, Guinea, Malawi, Nigeria, and Tanzania). Completion of maternal continuum of care was highest in South Africa (81.4%) and below 50% in nine of the 16 countries (Angola, Burundi, Ethiopia, Guinea, Malawi, Mali, Nigeria, Tanzania, and Uganda), the lowest being in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (concentration index = 0.04) and the highest in Nigeria (concentration index = 0.34). Our decomposition analysis showed that in 15 of the 16 countries, wealth index was the largest contributor to inequality in primary maternal continuum of care. In Malawi, geographical region was the largest contributor. Conclusions Addressing the coverage gap in maternal continuum of care in SSA using multidimensional and people-centred approaches remains a key strategy needed to realise the SDG3. The pro-rich wealth-based inequalities observed show that bespoke pro-poor or population-wide approaches are needed. |
| first_indexed | 2024-03-09T15:23:11Z |
| format | Article |
| id | doaj.art-2ef48369f9b8488489559bf035eae4a1 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-03-09T15:23:11Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-2ef48369f9b8488489559bf035eae4a12023-11-26T12:39:09ZengBMCInternational Journal for Equity in Health1475-92762023-10-0122111210.1186/s12939-023-02015-0Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countriesAnteneh Asefa0Samson Gebremedhin1Tiara Marthias2Herfina Nababan3Aliki Christou4Aline Semaan5Aduragbemi Banke-Thomas6Hanani Tabana7Fadhlun M. Alwy Al-beity8Jean-Paul Dossou9Keneni Gutema10Thérèse Delvaux11Catherine Birabwa12Mardieh Dennis13Fassou Mathias Grovogui14Barbara McPake15Lenka Beňová16Department of Public Health, Institute of Tropical MedicineSchool of Public Health, Addis Ababa UniversitySchool of Population and Global Health, Nossal Institute for Global Health, The University of MelbourneInstitut für Public Health und Pflegeforschung, Universität BremenDepartment of Public Health, Institute of Tropical MedicineDepartment of Public Health, Institute of Tropical MedicineSchool of Human Sciences, University of GreenwichSchool of Public Health, University of the Western CapeDepartment of Obstetrcis/Gynaecology, Muhimbili University of Health and Allied SciencesCentre de Recherche en Reproduction Humaine Et en DémographieSchool of Public Health, College of Medicine and Health Sciences, Hawassa UniversityDepartment of Public Health, Institute of Tropical MedicineMakerere University School of Public HealthLast Mile HealthCentre National de Formation Et de Recherche en Santé Rurale (CNFRSR)School of Population and Global Health, Nossal Institute for Global Health, The University of MelbourneDepartment of Public Health, Institute of Tropical MedicineAbstract Background Persistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based inequalities in coverage of maternal continuum of care in 16 SSA countries with the objective of informing targeted policies to ensure maternal health equity in the region. Methods We conducted a secondary analysis of Demographic and Health Survey (DHS) data from 16 SSA countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia). A total of 133,709 women aged 15-49 years who reported a live birth in the five years preceding the survey were included. We defined and measured completion of maternal continuum of care as having had at least one antenatal care (ANC) visit, birth in a health facility, and postnatal care (PNC) by a skilled provider within two days of birth. We used concentration index analysis to measure wealth-based inequality in maternal continuum of care and conducted decomposition analysis to estimate the contributions of sociodemographic and obstetric factors to the observed inequality. Results The percentage of women who had 1) at least one ANC visit was lowest in Ethiopia (62.3%) and highest in Burundi (99.2%), 2) birth in a health facility was less than 50% in Ethiopia and Nigeria, and 3) PNC within two days was less than 50% in eight countries (Angola, Burundi, Ethiopia, Gambia, Guinea, Malawi, Nigeria, and Tanzania). Completion of maternal continuum of care was highest in South Africa (81.4%) and below 50% in nine of the 16 countries (Angola, Burundi, Ethiopia, Guinea, Malawi, Mali, Nigeria, Tanzania, and Uganda), the lowest being in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (concentration index = 0.04) and the highest in Nigeria (concentration index = 0.34). Our decomposition analysis showed that in 15 of the 16 countries, wealth index was the largest contributor to inequality in primary maternal continuum of care. In Malawi, geographical region was the largest contributor. Conclusions Addressing the coverage gap in maternal continuum of care in SSA using multidimensional and people-centred approaches remains a key strategy needed to realise the SDG3. The pro-rich wealth-based inequalities observed show that bespoke pro-poor or population-wide approaches are needed.https://doi.org/10.1186/s12939-023-02015-0Antenatal careDemographic and health surveyFacility-based childbirthInequalityMaternal continuum of carePostnatal care |
| spellingShingle | Anteneh Asefa Samson Gebremedhin Tiara Marthias Herfina Nababan Aliki Christou Aline Semaan Aduragbemi Banke-Thomas Hanani Tabana Fadhlun M. Alwy Al-beity Jean-Paul Dossou Keneni Gutema Thérèse Delvaux Catherine Birabwa Mardieh Dennis Fassou Mathias Grovogui Barbara McPake Lenka Beňová Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries International Journal for Equity in Health Antenatal care Demographic and health survey Facility-based childbirth Inequality Maternal continuum of care Postnatal care |
| title | Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries |
| title_full | Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries |
| title_fullStr | Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries |
| title_full_unstemmed | Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries |
| title_short | Wealth-based inequality in the continuum of maternal health service utilisation in 16 sub-Saharan African countries |
| title_sort | wealth based inequality in the continuum of maternal health service utilisation in 16 sub saharan african countries |
| topic | Antenatal care Demographic and health survey Facility-based childbirth Inequality Maternal continuum of care Postnatal care |
| url | https://doi.org/10.1186/s12939-023-02015-0 |
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