Socioeconomic Inequalities Persist Despite Declining Stunting Prevalence in Low- and Middle-Income Countries

Abstract Background: The heavy and ever rising burden of non-communicable diseases (NCDs) in low- and middle-income countries (LMICs) warrants interventions to reduce unhealthy lifestyles. To effectively target these interventions, it is important to know how unhealthy lifestyles vary with socioeconomic characteristics. This study quantifies prevalence and socioeconomic inequalities in unhealthy lifestyles in LMICs, to identify policy priorities conducive to the Sustainable Development Goal of a one third reduction in deaths from NCDs by 2030.Methods: Data from 1,278,624 adult respondents to Demographic & Health Surveys across 22 LMICs between 2013 and 2018 are used to estimate crude prevalence rates and socioeconomic inequalities in tobacco use, overweight, harmful alcohol use and the clustering of these three in a household. Inequalities are measured by a concentration index and correlated with the percentage of GDP spent on health. We estimate a multilevel model to examine associations of individual characteristics with different unhealthy lifestyles.Results: The prevalence of tobacco use among men ranges from 59.6% (Armenia) to 6.6% (Nigeria). The highest level of overweight among women is 83.7% (Egypt) while this is less than 12% in Burundi, Chad and Timor-Leste. 82.5% of women in Burundi report that their partner is “often or sometimes drunk” compared to 1.3% in Gambia. Tobacco use is concentrated among the poor, except for the low share of men smoking in Nigeria. Overweight, however, is concentrated among the better off, especially in Tanzania and Zimbabwe (Erreygers Index (EI) 0.227 and 0.232). Harmful alcohol use is more concentrated among the better off in Nigeria (EI 0.127), while Chad, Rwanda and Togo show an unequal pro-poor distribution (EI respectively -0.147, -0.210, -0.266). Cambodia exhibits the largest socioeconomic inequality in unhealthy household behaviour (EI -0.253). The multilevel analyses confirm that in LMICs, tobacco and alcohol use are largely concentrated among the poor, while overweight is concentrated among the better-off.Conclusions: This study emphasizes the importance of unhealthy lifestyles in LMICs and the socioeconomic variation therein. Given the different socioeconomic patterns in unhealthy lifestyles - overweight patters in LMICs differ considerably from those in high income countries- tailored interventions towards specific high-risk populations are warranted.

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Comparing socioeconomic inequalities between early neonatal mortality and facility delivery: Cross-sectional data from 72 low- and middle-income countries

Scientific Reports ◽

10.1038/s41598-019-45148-5 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Terhi J. Lohela ◽

Robin C. Nesbitt ◽

Juha Pekkanen ◽

Sabine Gabrysch

Keyword(s):

Neonatal Mortality ◽

Socioeconomic Inequalities ◽

Facility Delivery ◽

Cross Sectional ◽

Middle Income ◽

Early Neonatal Mortality ◽

Middle Income Countries ◽

Low And Middle Income

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Do Socioeconomic Inequalities in Neonatal Mortality Reflect Inequalities in Coverage of Maternal Health Services? Evidence from 48 Low- and Middle-Income Countries

Maternal and Child Health Journal ◽

10.1007/s10995-015-1841-8 ◽

2015 ◽

Vol 20 (2) ◽

pp. 434-446 ◽

Cited By ~ 2

Author(s):

Britt McKinnon ◽

Sam Harper ◽

Jay S. Kaufman

Keyword(s):

Maternal Health ◽

Health Services ◽

Neonatal Mortality ◽

Maternal Health Services ◽

Socioeconomic Inequalities ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Inequalities in Antenatal Care Coverage and Quality: an Analysis From 63 Low and Middle-income Countries Using the ANCq Content-qualified Coverage Indicator

10.21203/rs.3.rs-120640/v1 ◽

2020 ◽

Author(s):

Luisa Arroyave ◽

Ghada E Saad ◽

Cesar G Victora ◽

Aluisio J D Barros

Keyword(s):

Antenatal Care ◽

Urban Areas ◽

Global Analysis ◽

Socioeconomic Inequalities ◽

Middle Income ◽

National Surveys ◽

Middle Income Countries ◽

Wide Range ◽

The Difference ◽

Low And Middle Income

Abstract Background: Antenatal care (ANC) is an essential intervention associated with a reduction of maternal and new-born morbidity and mortality. However, evidence suggested substantial inequalities in maternal and child health, mainly in low- and middle-income countries (LMICs). We aimed to conduct a global analysis of socioeconomic inequalities in ANC using national surveys from LMICs.Methods: ANC was measured using the ANCq, a novel content-qualified ANC coverage indicator, created and validated using national surveys, based upon contact with the health services and content of care received. We performed stratified analysis to explore the socioeconomic inequalities in ANCq. We also estimated the slope index of inequality, which measures the difference in coverage along the wealth spectrum. Results: We analyzed 63 national surveys carried out from 2010 to 2017. There were large inequalities between and within countries. Higher ANCq scores were observed among women living in urban areas, with secondary or more level of education, belonging to wealthier families and with higher empowerment in nearly all countries. Countries with higher ANCq mean presented lower inequalities; while countries with average ANCq scores presented wide range of inequality, with some managing to achieve very low inequality.Conclusions: Despite all efforts in ANC programs, important inequalities in coverage and quality of ANC services persist. If maternal and child mortality Sustainable Development Goals are to be achieved, those gaps we documented must be bridged.

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Socioeconomic inequalities in skilled birth attendance and child stunting in selected low and middle income countries: Wealth quintiles or deciles?

PLoS ONE ◽

10.1371/journal.pone.0174823 ◽

2017 ◽

Vol 12 (5) ◽

pp. e0174823 ◽

Cited By ~ 12

Author(s):

Kerry L. M. Wong ◽

María Clara Restrepo-Méndez ◽

Aluísio J. D. Barros ◽

Cesar G. Victora

Keyword(s):

Skilled Birth Attendance ◽

Socioeconomic Inequalities ◽

Middle Income ◽

Child Stunting ◽

Middle Income Countries ◽

Birth Attendance ◽

Low And Middle Income

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Trends in Socioeconomic Inequalities and Prevalence of Anemia Among Children and Nonpregnant Women in Low- and Middle-Income Countries

JAMA Network Open ◽

10.1001/jamanetworkopen.2018.2899 ◽

2018 ◽

Vol 1 (5) ◽

pp. e182899 ◽

Cited By ~ 7

Author(s):

Fan Yang ◽

Xueyi Liu ◽

Panpan Zha

Keyword(s):

Socioeconomic Inequalities ◽

Middle Income ◽

Middle Income Countries ◽

Prevalence Of Anemia ◽

Low And Middle Income

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Inequalities in antenatal care coverage and quality: an analysis from 63 low and middle-income countries using the ANCq content-qualified coverage indicator

International Journal for Equity in Health ◽

10.1186/s12939-021-01440-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Luisa Arroyave ◽

Ghada E. Saad ◽

Cesar G. Victora ◽

Aluisio J. D. Barros

Keyword(s):

Antenatal Care ◽

Urban Areas ◽

Global Analysis ◽

Socioeconomic Inequalities ◽

Middle Income ◽

National Surveys ◽

Middle Income Countries ◽

Wide Range ◽

The Difference ◽

Low And Middle Income

Abstract Background Antenatal care (ANC) is an essential intervention associated with a reduction of maternal and new-born morbidity and mortality. However, evidence suggested substantial inequalities in maternal and child health, mainly in low- and middle-income countries (LMICs). We aimed to conduct a global analysis of socioeconomic inequalities in ANC using national surveys from LMICs. Methods ANC was measured using the ANCq, a novel content-qualified ANC coverage indicator, created and validated using national surveys, based upon contact with the health services and content of care received. We performed stratified analysis to explore the socioeconomic inequalities in ANCq. We also estimated the slope index of inequality, which measures the difference in coverage along the wealth spectrum. Results We analyzed 63 national surveys carried out from 2010 to 2017. There were large inequalities between and within countries. Higher ANCq scores were observed among women living in urban areas, with secondary or more level of education, belonging to wealthier families and with higher empowerment in nearly all countries. Countries with higher ANCq mean presented lower inequalities; while countries with average ANCq scores presented wide range of inequality, with some managing to achieve very low inequality. Conclusions Despite all efforts in ANC programs, important inequalities in coverage and quality of ANC services persist. If maternal and child mortality Sustainable Development Goals are to be achieved, those gaps we documented must be bridged.

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Inequalities in antenatal care coverage and quality: an analysis from 63 low and middle-income countries using the ANCq content-qualified coverage indicator

10.1101/2020.11.11.20230102 ◽

2020 ◽

Author(s):

Luisa Arroyave ◽

Ghada E Saad ◽

Cesar G Victora ◽

Aluisio J D Barros

Keyword(s):

Antenatal Care ◽

Urban Areas ◽

Global Analysis ◽

Socioeconomic Inequalities ◽

Middle Income ◽

National Surveys ◽

Middle Income Countries ◽

Wide Range ◽

The Difference ◽

Low And Middle Income

AbstractObjectiveto conduct a global analysis of socioeconomic inequalities in antenatal care (ANC) using national surveys from low- and middle-income countries.MethodsANC was measured using the ANCq, a novel content-qualified ANC coverage indicator, created and validated using national surveys, based upon contact with the health services and content of care received. We performed stratified analysis to explore the socioeconomic inequalities in ANCq. We also estimated the slope index of inequality, which measures the difference in coverage along the wealth spectrum.ResultsWe analyzed 63 national surveys carried out from 2010 to 2017. There were large inequalities between and within countries. Higher ANCq scores were observed among women living in urban areas, with secondary or more level of education, belonging to wealthier families and with higher empowerment in nearly all countries. Countries with higher ANCq mean presented lower inequalities; while countries with average ANCq scores presented wide range of inequality, with some managing to achieve very low inequality.ConclusionsDespite all efforts in ANC programs, important inequalities in coverage and quality of ANC services persist. If maternal and child mortality Sustainable Development Goals are to be achieved, those gaps we documented must be bridged.

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Socioeconomic inequalities in the prevalence of underweight, overweight, and obesity among women aged 20–49 in low- and middle-income countries

International Journal of Obesity ◽

10.1038/s41366-019-0503-0 ◽

2019 ◽

Vol 44 (3) ◽

pp. 609-616 ◽

Cited By ~ 2

Author(s):

Ursula Reyes Matos ◽

Marilia Arndt Mesenburg ◽

Cesar G. Victora

Keyword(s):

Pearson Correlation ◽

National Income ◽

Correlation Coefficients ◽

Socioeconomic Inequalities ◽

Overweight And Obesity ◽

Middle Income ◽

Middle Income Countries ◽

Low Prevalence ◽

Overweight Or Obesity ◽

Low And Middle Income

Abstract Objective To analyze socioeconomic inequalities in the prevalence of underweight and overweight or obesity in women from low and middle-income countries (LMICs). Methods Using the last available Demographic Health Survey between 2010 and 2016 from 49 LMICs, we estimated the prevalence of underweight (BMI < 18.5 kg/m2) and overweight or obesity combined (BMI ≥ 25 kg/m2) for women aged 20–49 years. We used linear regression to explore the associations between the two outcomes and gross national income (GNI). We assess within-country socioeconomic inequalities using wealth deciles. The slope index of inequality (SII) and the inequality pattern index (IPI) were calculated for each outcome. Negative values of the latter express bottom inequality (when inequality is driven by the poorest deciles) while positive values express top inequality (driven by the richest deciles). Results In total, 931,145 women were studied. The median prevalence of underweight, overweight or obesity combined, and obesity were 7.3% (range 0.2–20.5%), 31.5% (8.8–85.3%), and 10.2% (1.9–48.8%), respectively. Pearson correlation coefficients with log GNI were −0.33 (p = 0.006) for underweight, 0.72 (p < 0.001) for overweight or obesity, and 0.66 (p < 0.001) for obesity. For underweight, the SII was significantly negative in 38 of the 49 countries indicating a higher burden among poor women. There was no evidence of top or bottom inequality. Overweight or obesity increased significantly with wealth in 44 of the 49 countries. Top inequality was observed in low-prevalence countries, and bottom inequality in high-prevalence countries. Conclusion Underweight remains a problem among the poorest women in poor countries, but overweight and obesity are the prevailing problem as national income increases. In low-prevalence countries, overweight or obesity levels are driven by the higher prevalence among the richest women; as national prevalence increases, only the poorest women are relatively preserved from the epidemic.

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