Dataset Information

Equity in Essential Maternal, Newborn, and Child Health Interventions in Northeastern China, 2008 to 2018.

ABSTRACT: Objectives: We aim to analyze equity in maternal, newborn, and child health (MNCH) interventions in Jilin, a northeastern province of China, 2008-2018. Study design: Cross-sectional study. Methods: We used provincially representative survey data from 2008, 2013, and 2018. We included 18 essential MNCH interventions, analyzed equity, and calculated the composite coverage score. We used logistic and multiple linear regressions to adjust sampling clusters and covariates. Results: Coverage of hospital-based interventions, such as hospital delivery and antenatal B-ultrasound tests, was nearly universal in Jilin province. Cesarean sections persisted at alarmingly high rates (57.6%). Enormous unmet needs and rural-urban inequalities existed for community-based interventions, such as improved drinking water sources (85.4 vs. 97.9%, p < 0.01), improved sanitation facilities (52.5 vs. 94.2%, p < 0.01), four government-funded antenatal care services (55.8 vs. 84.1%, p < 0.01), and at least eight antenatal care sessions (26.8 vs. 46.3%, p < 0.05). Compared to rural-urban inequity, individual-level disparities across income and education were either small in scale or statistically insignificant. The inequity in coverage of maternal and newborn care shrank during 2008-2018. Conclusions: Despite its success in reducing mortality, China's unique obstetrician-led safe motherhood strategy may come at the cost of over-medicalization and health inequity. Jilin province's recent efforts to revitalize primary health care show the potential to make a change. An integrated system that links families, communities, and all levels of health care organizations seems to be the most effective and efficient model to offer continuing MNCH care.

SUBMITTER: Wang Y

PROVIDER: S-EPMC7343890 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Equity in Essential Maternal, Newborn, and Child Health Interventions in Northeastern China, 2008 to 2018.

Wang Ying Y Liao Ran R Feng Xing Lin XL

Frontiers in public health 20200702

Objectives: We aim to analyze equity in maternal, newborn, and child health (MNCH) interventions in Jilin, a northeastern province of China, 2008-2018. Study design: Cross-sectional study. Methods: We used provincially representative survey data from 2008, 2013, and 2018. We included 18 essential MNCH interventions, analyzed equity, and calculated the composite coverage score. We used logistic and multiple linear regressions to adjust sampling clusters and covariates. Res ...[more]

PMID: 32714887

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Project description:ImportancePrevious work has underscored subnational inequalities that could impede additional health gains in Kenya.ObjectiveTo provide a comprehensive assessment of the burden, distribution, and change in inequalities in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) interventions in Kenya from 2003 to 2014.Design, setting, and participantsThis population-based cross-sectional study used data from the 2003, 2008, and 2014 Kenya Demographic and Health Surveys. The study included women of reproductive age (ages 15-49 years) and children younger than years, with national, regional, county, and subcounty level representation. Data analysis was conducted from April 2018 to November 2018.ExposuresSocioeconomic position that was derived from asset indices and presented as wealth quintiles. Urban and rural residence and regions of Kenya were also considered.Main outcomes and measuresAbsolute and relative measures of inequality in coverage of RMNCAH interventions.ResultsFor this analysis, representative samples of 31 380 women of reproductive age and 29 743 children younger than 5 years from across Kenya were included. The RMNCAH interventions examined demonstrated pro-rich and bottom inequality patterns. The most inequitable interventions were skilled birth attendance, family planning needs satisfied, and 4 or more antenatal care visits, whereby the absolute difference in coverage between the wealthiest (quintile 5) and poorest quintiles (quintile 1) was 61.6% (95% CI, 60.1%-63.1%), 33.4% (95% CI, 31.9%-34.9%), and 31.0% (95% CI, 30.5%-31.6%), respectively. The most equitable intervention was early initiation of breastfeeding, with an absolute difference (quintile 5 minus quintile 1) of -7.9% (95% CI, -11.1% to -4.8%), although antenatal care (1 visit) and diphtheria-tetanus-pertussis immunization (3 doses) demonstrated the best combination of high coverage and low inequalities. Our geospatial analysis revealed significant socioeconomic disparities in the northern and eastern regions of Kenya that have translated to suboptimal intervention coverage. A significant gap remains for rural, disadvantaged populations.Conclusions and relevanceCoverage of RMNCAH interventions has improved over time, but wealth and geospatial inequalities in Kenya are persistent. Policy and programming efforts should place more emphasis on improving the accessibility of health facility-based interventions, which generally demonstrate poor coverage and high inequalities, and focus on integrated approaches to maternal health service delivery at the community level when access is poor. Scaling up of health services for the urban and, in particular, rural poor areas and those residing in Kenya's former north eastern province will contribute toward achievement of universal health coverage.

Project description:Background: The pursuit of health equity is a priority in Ethiopia, especially with regards to maternal, newborn, and child health (MNCH). To date, there has been little characterization of the 'problem' of health inequity, and the normative assumptions implicit in the representation of the problem. Yet, such insights have implications for shaping the framing, incentivization, and implementation of health policies and their wider impact. Objective: In this article, we characterize how health (in)equity is represented as a policy issue, how this representation came about, and the underlying assumptions. Methods: We draw from Bacchi's 'what is the problem represented to be' approach to explore how national-level actors in the health sector constitute the problem. The data for our analysis encompass 23 key informant interviews with national health sector actors working in leadership positions on MNCH in Ethiopia, and six policy documents. Findings were derived from thematic and content analysis. Results: Health inequity is a normalized and inevitable concern that is regarded as actionable (can be altered) but not fully resolvable (can never be fully achieved). Operationally, health equity is viewed as a technocratic matter, reflected in the widespread use of metrics to motivate and measure progress. These representations are shaped by Ethiopia's rapid expansion of health services into rural areas during the 2000s leading to the positive international attention and funding the country received for improved MNCH indicators. Expanding the coverage and efficiency of health service provision, especially in rural areas, is associated with economic productivity. Conclusion: The metrication of health equity may detract from the fairness, justice, and morality underpinnings of the concept. The findings of this study point to the implications of global pressures in terms of maximizing health investments, and call into question how social, political, and economic determinants of health are addressed through broader development agendas.

Project description:Background Despite increasing focus on health inequities in low- and middle income countries, significant disparities persist. We analysed impacts of a statewide maternal and child health program among the most compared to the least marginalised women in Bihar, India. Methods Utilising survey-weighted logistic regression, we estimated programmatic impact using difference-in-difference estimators from Mathematica data collected at the beginning (2012, n?=?10?174) and after two years of program implementation (2014, n?=?9611). We also examined changes in disparities over time using eight rounds of Community-based Household Surveys (CHS) (2012-2017, n?=?48?349) collected by CARE India. Results At baseline for the Mathematica data, least marginalised women generally performed desired health-related behaviours more frequently than the most marginalised. After two years, most disparities persisted. Disparities increased for skilled birth attendant identification [+16.2% (most marginalised) vs +32.6% (least marginalized), P?<?0.01) and skin-to-skin care (+14.8% vs +20.4%, P?<?0.05), and decreased for immediate breastfeeding (+10.4 vs -4.9, P?<?0.01). For the CHS data, odds ratios compared the most to the least marginalised women as referent. Results demonstrated that disparities were most significant for indicators reliant on access to care such as delivery in a facility (OR range: 0.15 to 0.48) or by a qualified doctor (OR range: 0.08 to 0.25), and seeking care for complications (OR range: 0.26 to 0.64). Conclusions Disparities observed at baseline generally persisted throughout program implementation. The most significant disparities were observed amongst behaviours dependent upon access to care. Changes in disparities largely were due to improvements for the least marginalised women without improvements for the most marginalised. Equity-based assessments of programmatic impacts, including those of universal health approaches, must be undertaken to monitor disparities and to ensure equitable and sustainable benefits for all. Study registration ClinicalTrials.gov number NCT02726230

Project description:BackgroundNationally representative household surveys are the gold standard for tracking progress in coverage of life-saving maternal and child interventions, but often do not provide timely information on coverage at the local and health facility level. Electronic routine health information system (RHIS) data could help provide this information, but there are currently concerns about data quality. This analysis seeks to improve the usability of and confidence in electronic RHIS data by using adjustments to calculate more accurate numerators and denominators for essential interventions.MethodsData from three sources (Ugandan Demographic and Health (UDHS) survey, electronic RHIS, and census) were used to provide estimates of essential maternal (> 4 antenatal care visits (ANC), skilled delivery, and postnatal care visit (PNC)) and child health interventions (diphtheria, pertussis, tetanus, and hepatitis B and Haemophilus influenzae type b and polio vaccination series, measles vaccination, and vitamin A). Electronic RHIS data was checked for quality and both numerators and denominators were adjusted to improve accuracy. Estimates were compared between the three sources.ResultsEstimates of maternal health interventions from adjusted electronic RHIS data were lower than those of the UDHS, while child intervention estimates were typically higher. Adjustment of electronic RHIS data generally improved accuracy compared with no adjustment. There was considerable agreement between estimates from adjusted, electronic RHIS data, and UDHS for skilled delivery and first dose of childhood vaccination series, but lesser agreement for ANC visits and second and third doses of childhood vaccinations.ConclusionsNationally representative household surveys will likely continue being the gold standard of coverage estimates of maternal and child health interventions, but this analysis shows that current approaches to adjusting health facility estimate works better for some indications than others. Further efforts to improve accuracy of estimates from RHIS sources are needed.

Dataset Information

Equity in Essential Maternal, Newborn, and Child Health Interventions in Northeastern China, 2008 to 2018.

Publications

Equity in Essential Maternal, Newborn, and Child Health Interventions in Northeastern China, 2008 to 2018.

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