Are the poorest poor being left behind? Estimating global inequalities in reproductive, maternal, newborn and child health

IntroductionWealth-related inequalities in reproductive, maternal, neonatal and child health have been widely studied by dividing the population into quintiles. We present a comprehensive analysis of wealth inequalities for the composite coverage index (CCI) using national health surveys carried out since 2010, using wealth deciles and absolute income estimates as stratification variables, and show how these new approaches expand on traditional equity analyses.Methods83 low-income and middle-income countries were studied. The CCI is a combined measure of coverage with eight key reproductive, maternal, newborn and child health interventions. It was disaggregated by wealth deciles for visual inspection of inequalities, and the slope index of inequality (SII) was estimated. The correlation between coverage in the extreme deciles and SII was assessed. Finally, we used multilevel models to examine how the CCI varies according to the estimated absolute income for each wealth quintile in the surveys.ResultsThe analyses of coverage by wealth deciles and by absolute income show that inequality is mostly driven by coverage among the poor, which is much more variable than coverage among the rich across countries. Regardless of national coverage, in 61 of the countries, the wealthiest decile achieved 70% or higher CCI coverage. Well-performing countries were particularly effective in achieving high coverage among the poor. In contrast, underperforming countries failed to reach the poorest, despite reaching the better-off.ConclusionThere are huge inequalities between the richest and the poorest women and children in most countries. These inequalities are strongly driven by low coverage among the poorest given the wealthiest groups achieve high coverage irrespective of where they live, overcoming any barriers that are an impediment to others. Countries that ‘punched above their weight’ in coverage, given their level of absolute wealth, were those that best managed to reach their poorest women and children.

Download Full-text

The coverage of continuum of care in maternal, newborn and child health: a cross-sectional study of woman-child pairs in Ghana

BMJ Global Health ◽

10.1136/bmjgh-2018-000786 ◽

2018 ◽

Vol 3 (4) ◽

pp. e000786 ◽

Cited By ~ 9

Author(s):

Akira Shibanuma ◽

Francis Yeji ◽

Sumiyo Okawa ◽

Emmanuel Mahama ◽

Kimiyo Kikuchi ◽

...

Keyword(s):

Child Health ◽

Continuum Of Care ◽

Cross Sectional Study ◽

Health Facilities ◽

Cross Sectional ◽

Newborn And Child Health ◽

Care Services ◽

Women And Children ◽

And Child Health ◽

The Continuum

IntroductionThe continuum of care has recently received attention in maternal, newborn and child health. It can be an effective policy framework to ensure that every woman and child receives timely and appropriate services throughout the continuum. However, a commonly used measurement does not evaluate if a pair of woman and child complies with the continuum of care. This study assessed the continuum of care based on two measurements: continuous visits to health facilities (measurement 1) and receiving key components of services (measurement 2). It also explored individual-level and area-level factors associated with the continuum of care achievement and then investigated how the continuum of care differed across areas.MethodsIn this cross-sectional study in Ghana in 2013, the continuum of care achievement and other characteristics of 1401 pairs of randomly selected women and children were collected. Multilevel logistic regression was used to estimate the factors associated with the continuum of care and its divergence across 22 areas.ResultsThroughout the pregnancy, delivery and post-delivery stages, 7.9% of women and children achieved the continuum of care through continuous visits to health facilities (measurement 1). Meanwhile, 10.3% achieved the continuum of care by receiving all key components of maternal, newborn and child health services (measurement 2). Only 1.8% of them achieved it under both measurements. Women and children from wealthier households were more likely to achieve the continuum of care under both measurements. Women’s education and complications were associated with higher continuum of care services-based achievement. Variance of a random intercept was larger in the continuum of care services-based model than the visit-based model.ConclusionsMost women and children failed to achieve the continuum of care in maternal, newborn and child health. Those who consistently visited health facilities did not necessarily receive key components of services.

Download Full-text

Global Disease Outbreaks and Effects on Maternal, Newborn & Child Health in Global South, a Systematic Review

International Journal of TROPICAL DISEASE & Health ◽

10.9734/ijtdh/2020/v41i1130334 ◽

2020 ◽

pp. 47-58

Author(s):

O. Orjingene ◽

N. L. Akondeng ◽

A. Kone-Coulibaly ◽

T. Ogojah ◽

M. Ganama

Keyword(s):

Health Care ◽

Child Health ◽

Pregnant Women ◽

Low Income ◽

Hospital Admissions ◽

Disease Outbreaks ◽

Global South ◽

Hiv Positive ◽

Newborn And Child Health ◽

And Child Health

Background/Aim: The world has witnessed several disease outbreaks both in the past and in recent times. Apart from loss of lives as a result of such outbreaks, there are also disruptions in health care provision and utilization due to certain measures aimed at curtailing the spread of such outbreaks. This study aimed to seek evidence from existing literature on the effects of disease outbreaks on maternal, newborn and child health care in Global South. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used and 14 literatures met the inclusion criteria. Results: HIV/AIDS pandemic affected the Maternal Newborn and Child Health since increased cases of anaemia, hospital admissions, still births in HIV positive pregnant and cases of foetal anaemia reported in infants born from HIV positive pregnant women were reported. No COVID-19 pandemic related-effects on MNCH observed since no maternal deaths and transmission from infected pregnant women to their newborns reported. Indirect effects of pandemics on MNHC include reduced service delivery and demand/utilization as well as inaccessibility due to diverse reasons. Discussion: The Government should put in place palliative measures for low-income citizens; engage and sensitize women, pregnant women and their children on available health care services and mitigation measures in place to access with minimal or no risk of being infected in a secure environment.

Download Full-text

Commentary—District decision-making to strengthen maternal, newborn and child health services in low-income settings

Health Policy and Planning ◽

10.1093/heapol/czw103 ◽

2016 ◽

Vol 31 (suppl 2) ◽

pp. ii1-ii2

Author(s):

Kara Hanson ◽

Joanna Schellenberg

Keyword(s):

Decision Making ◽

Child Health ◽

Health Services ◽

Low Income ◽

Child Health Services ◽

Newborn And Child Health ◽

And Child Health

Download Full-text

Developing and implementing a novel mentorship model (4+ 1) for maternal, newborn and child health in Rwanda

BMC Health Services Research ◽

10.1186/s12913-020-05789-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Anaclet Ngabonzima ◽

Cynthia Kenyon ◽

Celestin Hategeka ◽

Aimee Josephine Utuza ◽

Paulin Ruhato Banguti ◽

...

Keyword(s):

Child Health ◽

Health Care Providers ◽

Low Income ◽

Program Effectiveness ◽

Low Income Countries ◽

Care Providers ◽

Mortality And Morbidity ◽

Newborn And Child Health ◽

Training Support ◽

And Child Health

Abstract Background There are a number of factors that may contribute to high mortality and morbidity of women and newborns in low-income countries. These include a shortage of competent health care providers (HCP) and a lack of sufficient continuous professional development (CPD) opportunities. Strengthening the skills and building the capacity of HCP involved in the provision of maternal, newborn and child health (MNCH) is essential to ensure quality care for mothers, newborns and children. To address this challenge in Rwanda, mentorship of HCPs was identified as an approach that could help build capacity, improve the provision of care and accelerate the reduction in maternal and neonatal mortality and morbidity. In this paper, we describe the development and implementation of a novel mentorship model named Four plus One (4+ 1) for MNCH in Rwanda. Methods The mentorship model built on the basis of inter-professional collaboration (IPC) was developed in early 2017 through consultations with different key actors. The design phase included refresher courses in specific skills and training course on mentoring. Field visits were conducted in 10 hospitals from June 2017 to February 2020. Hospital management teams (MT) were involved in the development and implementation of this mentorship model to ensure ownership of the program. Results Upon completion of planned visits to each hospital, a total of 218 HCPs were involved in the process. Reports prepared by mentors upon each mentorship visit and compiled by Training Support and Access Model (TSAM) for MNCH’CPD team, highlighted the mothers and newborns who were saved by both mentors and mentees. Also, different logbooks of mentees showed how the capacity of staff was strengthened, thereby suggesting effectiveness of the model. Through different mentorship coordination meetings, the model was much appreciated by the MTs of hospitals, especially the IPC component of the model and confirmed the program ‘effectiveness. Conclusion The initiation of a mentorship model built on IPC together with the involvement of the leadership of the hospital may be the cause effect of reduction of specific mortality and improve MNCH in low resource settings even when there are a limited number of specialists in the health facilities.

Download Full-text

Large and persistent subnational inequalities in reproductive, maternal, newborn and child health intervention coverage in sub-Saharan Africa

BMJ Global Health ◽

10.1136/bmjgh-2019-002232 ◽

2020 ◽

Vol 5 (1) ◽

pp. e002232 ◽

Cited By ~ 2

Author(s):

Cheikh Mbacké Faye ◽

Fernando C Wehrmeister ◽

Dessalegn Y Melesse ◽

Martin Kavao Kavao Mutua ◽

Abdoulaye Maïga ◽

...

Keyword(s):

Child Health ◽

Health Planning ◽

Capital City ◽

Sub Saharan Africa ◽

High Coverage ◽

Newborn And Child Health ◽

Essential Interventions ◽

Wide Range ◽

Sub Saharan ◽

And Child Health

Subnational inequalities have received limited attention in the monitoring of progress towards national and global health targets during the past two decades. Yet, such data are often a critical basis for health planning and monitoring in countries, in support of efforts to reach all with essential interventions. Household surveys provide a rich basis for interventions coverage indicators on reproductive, maternal, newborn and child health (RMNCH) at the country first administrative level (regions or provinces). In this paper, we show the large subnational inequalities that exist in RMNCH coverage within 39 countries in sub-Saharan Africa, using a composite coverage index which has been used extensively by Countdown to 2030 for Women’s, Children’s and Adolescent’s Health. The analyses show the wide range of subnational inequality patterns such as low overall national coverage with very large top inequality involving the capital city, intermediate national coverage with bottom inequality in disadvantaged regions, and high coverage in all regions with little inequality. Even though nearly half of the 34 countries with surveys around 2004 and again around 2015 appear to have been successful in reducing subnational inequalities in RMNCH coverage, the general picture shows persistence of large inequalities between subnational units within many countries. Poor governance and conflict settings were identified as potential contributing factors. Major efforts to reduce within-country inequalities are required to reach all women and children with essential interventions.

Download Full-text