Equity trends in ownership of insecticide-treated nets in 19 sub-Saharan African countries

Taylor, Cameron; Florey, Lia; Yé, Yazoumé

doi:10.2471/blt.16.172924

Cited by 27 publications

(25 citation statements)

References 26 publications

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“…A recent study on equity trends in ownership of ITNs involving eight West African countries (including Benin, Burkina Faso, Mali, Nigeria, Senegal etc.) and 11 other sub-Saharan African countries, showed that richer households were more likely to own ITNs than the poorest households [ 45 ]. The relatively lower percentage of ITNs possession by the population of the poorest quintile has been attributed to their inability to afford the cost of the ITNs and probably as a result of low access to health care among the poorest populations [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

Using equitable impact sensitive tool (EQUIST) to promote implementation of evidence informed policymaking to improve maternal and child health outcomes: a focus on six West African Countries

et al. 2018

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BackgroundUnited Nations Children’s Fund (UNICEF) designed EQUitable Impact Sensitive Tool (EQUIST) to enable global health community address the issue of equity in maternal, newborn and child health (MNCH) and minimize health disparities between the most marginalized population and the better-off. The purpose of this study was to use EQUIST to provide reliable evidence, based on demographic health surveys (DHS) on cost–effectiveness and equitable impact of interventions that can be implemented to improve MNCH outcomes in Benin, Burkina Faso, Ghana, Mali, Nigeria and Senegal.MethodsUsing the latest available DHS data sets, we conducted EQUIST Situation Analysis of maternal and child health outcomes in the six countries by sub-national categorization, wealth and by residence. We then identified the poorest population class within each country with the highest maternal and child mortality and performed EQUIST Scenario Analysis of this population to identify intervention package, bottlenecks and strategies to address them, cost of the intervention and strategies as well as the number of deaths avertible.ResultsUnder-five mortality was highest in Atlantique (Benin), Sahel (Burkina Faso), Northern (Ghana), Sikasso (Mali), North-West (Nigeria), and Diourbel (Senegal). The number of under-five deaths was considerably higher among the poorest and rural population. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Ante-partum, intra-partum, and post-partum haemorrhages, and hypertensive disorder, were responsible for highest maternal deaths. The national average for improved water source was highest in Ghana (82%). Insecticide treated nets ownership percentage national average was highest in Benin (73%). Delivery by skilled professional is capable of averting the highest number of under-five and maternal deaths in the six countries. Redeployment/relocation of existing staff was the strategy with highest costs in Burkina Faso, Nigeria and Senegal. Ghana recorded the least cost per capita ($0.39) while the highest cost per capita was recorded in Benin ($4.0).ConclusionEQUIST highlights the most vulnerable and deprived children and women needing urgent health interventions as a matter of priority. It will continue to serve as a tool for maximizing the number of lives saved; decreasing health disparities and improving overall cost effectiveness.Electronic supplementary materialThe online version of this article (10.1186/s12992-018-0422-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Using equitable impact sensitive tool (EQUIST) to promote implementation of evidence informed policymaking to improve maternal and child health outcomes: a focus on six West African Countries

et al. 2018

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“…These poor households and communities are not identified in national surveys for targeted interventions. Evidence for improving household ownership of ITN through mass distribution campaigns has yielded mixed results in sub-Saharan Africa; in some countries, equity between the relatively wealthier and the less wealthy has increased, while in others, it decreased [ 30 – 32 ]. Deliberately addressing inequity and specifically developing strategies aimed at improving community socio-economic status may improve malaria control for poor communities [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study

Kabaghe

Chipeta

McCann

et al. 2018

Malar J

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BackgroundDespite the availability of cost effective malaria control interventions, such as insecticide-treated bed nets (ITN), diagnosis and effective treatment of malaria, and intermittent preventive treatment during pregnancy (IPTp), the lack of equitable access and coverage affect utilization of these interventions in rural communities. Aggregated rates of access and utilization of malaria interventions in national surveys mask substantial variations in intervention coverage. Utilization of interventions and factors affecting utilization need investigation in rural communities.MethodsOne year of quantitative data collected from a rolling Malaria Indicator Survey (April 2015–April 2016) in Chikhwawa District, Malawi, before the ITN distribution campaign, were analysed. Univariate analyses were used to quantify rates of ITN usage, care-seeking for fever in children aged 6–59 months and women aged 15–49 years and IPTp uptake (for women aged 15–49 years with a recent delivery). Results were compared to national survey estimates; factors associated with these outcomes were determined using multivariate regression models.ResultsA total of 2046 participants were included from 1328 households; 56.6% were women aged 15–49 years and 43.4% were children aged 6–59 months. Reported ownership of at least one ITN per household and under-five children ITN use the previous night were 35.3 and 33.5% compared to 70.2 and 67.1%, respectively, in the national survey; ITN use was higher in high wealth quintile households than low quintile ones. For participants with recent fever, 37.6 and 19.5% sought care and sought care within 24 h, respectively. Care-seeking was lower for febrile women than febrile children [aOR, 95% CI 0.53 (0.35–0.81)]. Uptake of two and three or more doses of IPTp were 40.6 and 15.0%, respectively, among women with a pregnancy in the last 2 years.ConclusionTo achieve effective malaria control, fine-scale or district-based surveillance should be used to identify and target communities requiring scaling up of interventions. Qualitative research and a participatory community approach should be used to address behavioural factors affecting how people make use of interventions.

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“…Several multi-country analyses included ITN use among children under the age of five into a composite index for maternal and child health to track country and regional progress toward the Millennium Development Goals [ 22 ]; these studies found that, although relative inequalities have generally been narrowing, appreciable differences between the poorest and the least poor persist. There have been a number of evaluations that focused on a single malaria intervention (most commonly ITNs) [ 23 , 24 ]. To the best of our knowledge, only one earlier study [ 5 ] has assessed equity across a range of malaria interventions in a large number of endemic African countries.…”

Section: Introductionmentioning

confidence: 99%

State of inequality in malaria intervention coverage in sub-Saharan African countries

Galactionova

Smith

Savigny

et al. 2017

BMC Med

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BackgroundScale-up of malaria interventions over the last decade have yielded a significant reduction in malaria transmission and disease burden in sub-Saharan Africa. We estimated economic gradients in the distribution of these efforts and of their impacts within and across endemic countries.MethodsUsing Demographic and Health Surveys we computed equity metrics to characterize the distribution of malaria interventions in 30 endemic countries proxying economic position with an asset-wealth index. Gradients were summarized in a concentration index, tabulated against level of coverage, and compared among interventions, across countries, and against respective trends over the period 2005–2015.ResultsThere remain broad differences in coverage of malaria interventions and their distribution by wealth within and across countries. In most, economic gradients are lacking or favor the poorest for vector control; malaria services delivered through the formal healthcare sector are much less equitable. Scale-up of interventions in many countries improved access across the wealth continuum; in some, these efforts consistently prioritized the poorest. Expansions in control programs generally narrowed coverage gaps between economic strata; gradients persist in countries where growth was slower in the poorest quintile or where baseline inequality was large. Despite progress, malaria is consistently concentrated in the poorest, with the degree of inequality in burden far surpassing that expected given gradients in the distribution of interventions.ConclusionsEconomic gradients in the distribution of interventions persist over time, limiting progress toward equity in malaria control. We found that, in countries with large baseline inequality in the distribution of interventions, even a small bias in expansion favoring the least poor yielded large gradients in intervention coverage while pro-poor growth failed to close the gap between the poorest and least poor. We demonstrated that dimensions of disadvantage compound for the poor; a lack of economic gradients in the distribution of malaria services does not translate to equity in coverage nor can it be interpreted to imply equity in distribution of risk or disease burden. Our analysis testifies to the progress made by countries in narrowing economic gradients in malaria interventions and highlights the scope for continued monitoring of programs with respect to equity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-017-0948-8) contains supplementary material, which is available to authorized users.

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Equity trends in ownership of insecticide-treated nets in 19 sub-Saharan African countries

Cited by 27 publications

References 26 publications

Using equitable impact sensitive tool (EQUIST) to promote implementation of evidence informed policymaking to improve maternal and child health outcomes: a focus on six West African Countries

Using equitable impact sensitive tool (EQUIST) to promote implementation of evidence informed policymaking to improve maternal and child health outcomes: a focus on six West African Countries

Access and adequate utilization of malaria control interventions in rural Malawi: a descriptive quantitative study

State of inequality in malaria intervention coverage in sub-Saharan African countries

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