Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys

Abstract

Background Inequalities in neonatal mortality rates (NMRs) in low- and middle-income countries show key disparities at the detriment of disadvantaged population subgroups. There is a lack of scholarly evidence on the extent and reasons for the inequalities in NMRs in Angola. Objective The aim of this study was to assess the socio-economic, place of residence, region and gender inequalities in the NMRs in Angola. Methods The World Health Organization Health Equity Assessment Toolkit software was used to analyse data from the 2015 Angola Demographic and Health Survey. Five equity stratifiers: subnational regions, education, wealth, residence and sex were used to disaggregate NMR inequality. Absolute and relative inequality measures, namely, difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio, were calculated to provide a broader understanding of the inequalities in NMR. Statistical significance was calculated at corresponding 95% uncertainty intervals. Findings We found significant wealth-driven [PAR = −14.16, 95% corresponding interval (CI): −15.12, −13.19], education-related (PAF = −22.5%, 95% CI: −25.93, −19.23), urban–rural (PAF = −14.5%, 95% CI: −16.38, −12.74), sex-based (PAR = −5.6%, 95% CI: −6.17, −5.10) and subnational regional (PAF = −82.2%, 95% CI: −90.14, −74.41) disparities in NMRs, with higher burden among deprived population subgroups. Conclusions High NMRs were found among male neonates and those born to mothers with no formal education, poor mothers and those living in rural areas and the Benguela region. Interventions aimed at reducing NMRs, should be designed with specific focus on disadvantaged subpopulations.

Disparities in use of skilled birth attendants and neonatal mortality rate in Guinea over two decades

“…Pro-rich inequalities in SBA in Guinea are consistent with previous studies in Bangladesh [ 44 – 46 ]. Gender-based variations of NMR observed in Guinea were comparable with prior studies in Burundi and Angola [ 31 , 47 ]. Possible reasons could be due to inability to afford costs related to childbirth among households with lower socio-economic status [ 46 ].…”

“…Profound pro-urban inequalities in SBA and NMR are comparable with prior studies in Angola and Burundi [ 31 , 47 ]. Urban-rural differences in SBA have been reported in previous studies in Ethiopia and Bangladesh [ 46 , 51 ].…”

“…Important geographic-based disparities in SBA and NMR were comparable with studies in Tanzania, Benin, Angola, and Burundi [ 31 , 47 , 58 – 60 ]. Number of health personnel and health facilities, availability of essential medicines or supplies and the quality of care may explain differences in SBA coverage across regions [ 60 ].…”

Predictors of Neonatal Mortality in Ethiopia: Cross-Sectional Study Using 2005, 2010, and 2016 Ethiopian Demographic Health Survey Datasets.

“…The WHO recommends spacing childbirths at least 24-36 months apart (16). Moreover, previous studies conducted in Angola (17), Uganda(18) and LMICs (19) have shown that place of residence, maternal age at rst birth, birth weight, household wealth index, and maternal education were all signi cantly associated with neonatal mortality.…”

Predictors of neonatal mortality in Ethiopia: Cross sectional study using 2005, 2010 and 2016 Ethiopian demographic health survey datasets

“…The WHO recommends spacing childbirths at least 24-36 months apart [16]. Moreover, previous studies conducted in Angola [17], Uganda [18] and other LMICs [19] have shown that place of residence, maternal age at first birth, birth weight, household wealth index, and maternal education were all significantly associated with neonatal mortality.…”