District level inequality in reproductive, maternal, neonatal and child health coverage in India

Panda, Basant Kumar; Kumar, Gulshan; Awasthi, Ashish

doi:10.1186/s12889-020-8151-9

Cited by 24 publications

(21 citation statements)

References 31 publications

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“…Equal weighting schemes have been used successfully in creating indices related to infectious disease, 61 UHC 67 68 maternal and child health. 69 70 It has also been shown that the index created through principal component analysis is highly correlated with an index created through various weighting schemes and that arbitrarily defined weights did not make any difference to the composite coverage index. 60 71 In Mexico, a comparison of equal weights and weighting based on the total health gains yielded similar results.…”

Section: Methodsmentioning

confidence: 99%

“…An equal weighting scheme was implemented for all the determinants as routinely applied. [67][68][69][70] Equal weighting schemes have shown to be equally robust; 56 58 60 61 65 71 however, the weighting scheme can be revised as more individual-level COVID-19 data with attributes become available in Kenya and other countries across Africa. This will allow a better definition of how the risks associated with different variables vary across different populations and settings.…”

Section: Bmj Global Healthmentioning

confidence: 99%

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A vulnerability index for COVID-19: spatial analysis at the subnational level in Kenya

2020

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BackgroundResponse to the coronavirus disease 2019 (COVID-19) pandemic calls for precision public health reflecting our improved understanding of who is the most vulnerable and their geographical location. We created three vulnerability indices to identify areas and people who require greater support while elucidating health inequities to inform emergency response in Kenya.MethodsGeospatial indicators were assembled to create three vulnerability indices; Social VulnerabilityIndex (SVI), Epidemiological Vulnerability Index (EVI) and a composite of the two, that is, Social Epidemiological Vulnerability Index (SEVI) resolved at 295 subcounties in Kenya. SVI included 19 indicators that affect the spread of disease; socioeconomic deprivation, access to services and population dynamics, whereas EVI comprised 5 indicators describing comorbidities associated with COVID-19 severe disease progression. The indicators were scaled to a common measurement scale, spatially overlaid via arithmetic mean and equally weighted. The indices were classified into seven classes, 1–2 denoted low vulnerability and 6–7, high vulnerability. The population within vulnerabilities classes was quantified.ResultsThe spatial variation of each index was heterogeneous across Kenya. Forty-nine northwestern and partly eastern subcounties (6.9 million people) were highly vulnerable, whereas 58 subcounties (9.7 million people) in western and central Kenya were the least vulnerable for SVI. For EVI, 48 subcounties (7.2 million people) in central and the adjacent areas and 81 subcounties (13.2 million people) in northern Kenya were the most and least vulnerable, respectively. Overall (SEVI), 46 subcounties (7.0 million people) around central and southeastern were more vulnerable, whereas 81 subcounties (14.4 million people) were least vulnerable.ConclusionThe vulnerability indices created are tools relevant to the county, national government and stakeholders for prioritisation and improved planning. The heterogeneous nature of the vulnerability indices underpins the need for targeted and prioritised actions based on the needs across the subcounties.

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Section: Methodsmentioning

confidence: 99%

Section: Bmj Global Healthmentioning

confidence: 99%

A vulnerability index for COVID-19: spatial analysis at the subnational level in Kenya

2020

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“…rural versus urban [28]. Studies in India also showed that the underprivileged groups like the nancially weak, poorly literate, or living in rural areas, had limited access to healthcare services, thus leading to poorer outcomes for health [29] [30]. Similar ndings were observed in the case of Pakistan and for the provinces except for Balochistan where the inequities continue to prevail in the same ratio during throughout the last decade.…”

Section: Discussionmentioning

confidence: 60%

Assessing Neo-natal mortality trends in Pakistan: An insight using Equity Lens

Dawood¹

2020

Preprint

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BackgroundAlmost 2.5 million children died in the first year of life in the year 2017. These account for almost half of the total deaths of children under the age of five years. Overall, child mortality has declined over the past two decades. Comparatively, the pace of decline in neonatal mortality has remained much slow. Significant inequalities in health across a number of dimensions – including wealth, ethnicity, and geography – continue to exist both between and within countries, and these contribute to neonatal mortality. This study aims to quantify the magnitude of inequalities in neonatal mortality trends by wealth quintile and place of residence with province wise segregation. MethodsThe study was done using raw data from the last three Pakistan Demographic & Health Surveys (20017-18, 2012-13 and 2006-7). The concentration curves were drawn in Microsoft Excel 365 using scatter plot as graph type while the frequencies were calculated using SPSS 24. ResultsThe situation of inequity across provinces and in rural vs urban areas has slightly declined, however, gross inequities continue to exist.ConclusionsPresentation of outcomes data, such as neonatal mortality in various wealth quintiles is an effective way to highlight the inequities amongst income groups as it highlights the vulnerable and at-risk groups. In other countries, rural-urban distribution, or ethnic groups may also reflect similar differences and help in identifying high-risk groups.

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“…Moreover, previous studies in the Indian context have found signi cant disparities in MCH service coverage and e ciency in service delivery across districts in India [51,52].…”

Section: Methodsmentioning

confidence: 96%

Public Health Insurance and Maternal Health Care Utilization in India: Evidence from a 2005-2012 Mothers’ Cohort Study

Gebremedhin

Mohanty

Niyonsenga

2020

Preprint

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Background: Janani Suraksha Yojana (JSY), a conditional cash transfer program in India, incentivized women to deliver at institutions and resulted in a significant increase in institutional births. Another major health policy reform, which could have influenced maternal and child health care (MCH) utilisation, was the public health insurance scheme called Rashtriya Swasthya Bima Yojana (RSBY) launched in 2008. However, there is lack of evidence on how RSBY impacted MCH utilisation in India. This study investigated the impact of health insurance (in particular, the public insurance scheme versus private insurance) on a continuum of MCH utilisation. We also investigated whether maternal empowerment was a significant correlate that affects MCH utilisation. Methods: The study used a multilevel mixed effect ordered logistic regression modelling, using a cohort of mothers whose delivery was captured in both the 2005 and 2011/12 rounds of the Indian Human Development Survey (IHDS). We derived indexes for women’s empowerment using Principal component analysis (PCA) technique applied to various indicators of women’s autonomy and socio-economic status. Results: Our results indicated, mothers’ MCH utilization levels vary by district, community and mother over time. The effect of the public insurance scheme (RSBY) on MCH utilisation was not as strong as privately available insurance. However, health insurance was only significant in models that did not control for household and mother level predictors. Our findings indicated that maternal empowerment indicators – in particular, maternal ability to go out of the house and complete chores and economic empowerment - were associated with higher utilization of MCH services. Among control variables, maternal age, education and household wealth were significant correlates that increase MCH service utilization over time. Conclusions: Change in women’s and societal attitude towards maternal care may have played a significant role in increasing MCH utilisation over the study period. There might be a need to increase the coverage of the public insurance scheme given the finding that it was less effective in increasing MCH utilisation. Importantly, policies that aim to improve health services for women need to take maternal autonomy and empowerment into consideration.

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District level inequality in reproductive, maternal, neonatal and child health coverage in India

Cited by 24 publications

References 31 publications

A vulnerability index for COVID-19: spatial analysis at the subnational level in Kenya

A vulnerability index for COVID-19: spatial analysis at the subnational level in Kenya

Assessing Neo-natal mortality trends in Pakistan: An insight using Equity Lens

Public Health Insurance and Maternal Health Care Utilization in India: Evidence from a 2005-2012 Mothers’ Cohort Study

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