Inequalities in child mortality in ten major African cities

Quentin, Wilm; Abosede, Olayinka A.; Aka, Joseph; Akweongo, Patricia; Dinard, Kouassi; Ezeh, Alex; Hamed, Ramadan; Kayembé, Patrick; Mitike, Getnet; Mtei, Gemini; Bonle, Marguerite Te; Sundmacher, Leonie

doi:10.1186/1741-7015-12-95

Cited by 29 publications

(36 citation statements)

References 49 publications

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“…The opposite was true for conflict countries; this is in line with a study on breast feeding in violent conflict situations in Iraq which found that breastfeeding incidence reduced as casualties from armed conflict rose 34. This finding could be explained by the reduced health staff,11 25 35 user fees,6 25 36 and geographical barriers25 arising from conflict, as many women are counselled in breastfeeding practices,34 37 and support from health professionals has been found to be a key determinant of breast feeding 34. Alternately, mothers in conflict countries who have been displaced could have impaired nutritional intake, thus reducing breastmilk quality and a decline in breast feeding.…”

Section: Discussionsupporting

confidence: 73%

Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival

et al. 2020

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IntroductionConflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs).MethodsWe carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15–49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1–59 months) and school-aged children and adolescents (5–14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0–5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea.ResultsConflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries.ConclusionsInequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas.

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Section: Discussionsupporting

confidence: 73%

Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival

et al. 2020

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“…The comparable rates for post-neonatal mortality (one month to one year) in low versus high SDI countries, were 23.2 and 1.4 deaths per 1,000 live births, and among children aged between one and five years, 24.4 and 0.8 deaths per 1,000 live births, respectively [2]. A study which systematically compared household wealth inequalities in child mortality in 10 African cities between 2000, 2007 and 2011 showed wide disparities across time and place [7].…”

Section: Introductionmentioning

confidence: 99%

Inequalities in early childhood mortality in Myanmar - Association between parents’ socioeconomic status and early childhood mortality

Williams

Sommar

2019

Global Health Action

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Background: Despite global achievements in reducing early childhood mortality, disparities remain. There have been empirical studies of inequalities conducted in low-and middleincome countries. However, there have been no epidemiological studies on socioeconomic inequalities and early childhood survival in Myanmar. Objective: To estimate associations between two measures of parental socioeconomic statushousehold wealth and educationand age-specific early childhood mortality in Myanmar. Methods: Using cross-sectional data obtained from the Myanmar Demographic Health Survey (2015-2016), univariate and multiple logistic regressions were performed to investigate associations between household wealth and highest attained parental education, and under-5, neonatal, post-neonatal and child mortality. Data for 10,081 children born to 5,932 married women (aged 15-49 years) 10 years prior to the survey, were analysed. Results: Mortality during the first five years was associated with household wealth. In multiple logistic models, wealth was protective for post-neonatal mortality. After adjusting for individual proximate determinants, the odds of post-neonatal mortality in the richest households were 85% lower (95% CI: 50-96%) than in the poorest households. However, significant association was not found between wealth and neonatal mortality. Parental education was important for early childhood mortality; the highest benefit from parental education was for child mortality in the one-to five-year age bracket. After adjusting for proximate determinants, children with a higher educated parent had 95% (95% CI 77-99%) lower odds of death in this age group compared with children whose parents' highest educational attainment was at primary level. The association between parental education and neonatal mortality was not significant. Conclusions: In Myanmar, household wealth and parental education are important for childhood survival before five years of age. This study identified nuanced age-related differences in associations. Health policy must take socioeconomic determinants into account in order to address unfair inequalities in early childhood mortality. ARTICLE HISTORY

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“… 3 5 Such disparities in uptake of health services lead to the continuing problem of high child mortality especially among the poorest. 6 …”

Section: Introductionmentioning

confidence: 99%

Wealth-related inequality in early uptake of HIV testing among pregnant women: an analysis of data from a national cross-sectional survey, South Africa

Ngandu

Malderen

Goga³

et al. 2017

BMJ Open

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ObjectivesWealth-related inequality across the South African antenatal HIV care cascade has not been considered in detail as a potential hindrance to eliminating mother-to-child HIV transmission (EMTCT). We aimed to measure wealth-related inequality in early (before enrolling into antenatal care) uptake of HIV testing and identify the contributing determinants.DesignCross-sectional survey.SettingsSouth African primary public health facilities in 2012.ParticipantsA national-level sample of 8618 pregnant women.Outcome measuresWealth-related inequality in early uptake of HIV testing was measured using the Erreygers concentration index (CI) further adjusted for inequality introduced by predicted healthcare need (ie, need-standardised). Determinants contributing to the observed inequality were identified using the Erreygers and Wagstaff decomposition methods.ResultsParticipants were aged 13 to 49 years. Antenatal HIV prevalence was 33.2%, of which 43.7% came from the lowest 40% wealth group. A pro-poor wealth-related inequality in early HIV testing was observed. The need-standardised concentration index was −0.030 (95% confidence interval −0.038 to −0.022). The proportion of early HIV testing was significantly better in the lower 40% wealth group compared with the higher 40% wealth group (p value=0.040). The largest contributions to the observed inequality were from underlying inequalities in province (contribution, 65.27%), age (−44.38%), wealth group (24.73%) and transport means (21.61%).ConclusionsOur results on better early uptake of HIV testing among the poorer subpopulation compared with the richer highlights inequity in uptake of HIV testing in South Africa. This socioeconomic difference could contribute to fast-tracking EMTCT given the high HIV prevalence among the lower wealth group. The high contribution of provinces and age to inequality highlights the need to shift from reliance on national-level estimates alone but identify subregional-specific and age-specific bottlenecks. Future interventions need to be context specific and tailored for specific subpopulations and subregional settings.

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Inequalities in child mortality in ten major African cities

Cited by 29 publications

References 49 publications

Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival

Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival

Inequalities in early childhood mortality in Myanmar - Association between parents’ socioeconomic status and early childhood mortality

Wealth-related inequality in early uptake of HIV testing among pregnant women: an analysis of data from a national cross-sectional survey, South Africa

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