Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis

McKinnon, Britt; Harper, Sam; Kaufman, Jay S.; Bergevin, Yves

doi:10.1016/s2214-109x(14)70008-7

Cited by 107 publications

(133 citation statements)

References 25 publications

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“…This finding is consistent with other studies undertaken all over the globe. 2-9 Notably, although pro-rich inequality remains, inequality in neonatal mortality declined by 16% in Iran between 1995-2000 and 2005-2010, just like in Cameroon, Nigeria, Malawi, Mozambique, Uganda, 6 and in Chile. 3 In recent years, healthcare system in Iran has successfully launched some primary healthcare-based programs such as IMCI, well baby care, 1-59 months child mortality surveillance system, integrated mothers’ healthcare, and baby-friendly hospital initiative that gradually have removed geographical and financial barriers to newborn and maternal health services.…”

Section: Discussionmentioning

confidence: 98%

Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis

Rarani

Rashidian

Khosravi

et al. 2016

Int J Health Policy Manag

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Background: Exploring changes in health inequality and its determinants over time is of policy interest. Accordingly, this study aimed to decompose inequality in neonatal mortality into its contributing factors and then explore changes from 1995-2000 to 2005-2010 in Iran. Methods: Required data were drawn from two Iran’s demographic and health survey (DHS) conducted in 2000 and 2010. Normalized concentration index (CI) was used to measure the magnitude of inequality in neonatal mortality. The contribution of various determinants to inequality was estimated by decomposing concentration indices in 1995-2000 and 2005-2010. Finally, changes in inequality were investigated using Oaxaca-type decomposition technique. Results: Pro-rich inequality in neonatal mortality was declined by 16%, ie, the normalized CI dropped from -0.1490 in 1995-2000 to -0.1254 in 2005-2010. The largest contribution to inequality was attributable to mother’s education (32%) and household’s economic status (49%) in 1995-2000 and 2005-2010, respectively. Changes in mother’s educational level (121%), use of skilled birth attendants (79%), mother’s age at the delivery time (25-34 years old) (54%) and using modern contraceptive (29%) were mainly accountable for the decrease in inequality in neonatal mortality. Conclusion: Policy actions on improving households’ economic status and maternal education, especially in rural areas, may have led to the reduction in neonatal mortality inequality in Iran.

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Section: Discussionmentioning

confidence: 98%

Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis

Rarani

Rashidian

Khosravi

et al. 2016

Int J Health Policy Manag

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“…It is possible that in addition to individual-level factors, macro-level characteristics such as physical environment, residential segregation, social inequalities and discrimination, which "get under the skin," result in higher neonatal mortality among Dalits, especially those at the bottom of the social and economic hierarchy. Presumably, these factors discourage many Dalits to avail and/or utilize antenatal and prenatal ser-vices and healthcare facilities for child delivery (Chalasani 2012;McKinnon et al 2014;Paudel et al 2013), and also result in stress-related birth outcomes, such as preterm deliveries (Pike 2005) and low birth weight (Ellen 2000). Certain traditional and cultural practices and beliefs associated with pregnancy and childbirth may also be responsible for excess neonatal mortality among Dalits (Ghosh 2012;Kesterton and Cleland 2009).…”

Section: Discussionmentioning

confidence: 99%

The persistent caste divide in India’s infant mortality: A study of Dalits (ex-untouchables), Adivasis (indigenous peoples), Other Backward Classes, and forward castes

Ram

Singh

Yadav

2017

CSP

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Using data from two national surveys, this paper examines caste differences in infant mortality in India. We find that children from the three lower caste groups—Dalits (ex-untouchables), Adivasis (indigenous peoples), and Other Backward Classes—are significantly more likely than forward-caste children to die young. While this observation largely mirrors caste differences in socioeconomic conditions, low socioeconomic status is found to be only a partial explanation for higher infant mortality among lower castes. Higher mortality risks among backward-class children are almost entirely attributable to background characteristics. However, Dalit children are most vulnerable in the neonatal period even when all background characteristics are taken into account, whereas Adivasi children remain highly vulnerable in the post-neonatal period.Au moyen des données provenant des deux enquêtes nationales, cet article examine les différences dans la mortalité infantile par caste en Inde. Nous constatons que, par rapport aux enfants des castes élevées, ceux des trois castes inférieures, notamment les dalits (les ex-intouchables), les adivasis (peuples indigènes) et autres classes défavorisées (plusieurs castes désignées comme appartenant à un groupe défavorisé) courent un risque beaucoup plus grand de mourir jeunes. Bien que cette observation reflète largement les différences entre les castes sur le plan socioéconomique, le faible niveau socioéconomique n’explique qu’en partie le taux de mortalité plus élevé chez les castes inférieures. Les risques de mortalité des enfants des castes inférieures étaient presque entièrement attribuables aux caractéristiques des antécédents de la mère. Cependant, les enfants dalits demeurent les plus vulnérables pendant la période néonatale, bien que le risque de mortalité demeure le même que celui des enfants des castes supérieures pour la période post-néonatale. L’inverse est vrai pour les enfants adivasis : les caractéristiques des antécédents expliquent leur plus grande vulnérabilité pendant la période néonatale, mais pas pendant la période post-néonatale.

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“…Although this approach is intuitive, we also present the slope index of inequality for each outcome generated using the same mixed-effects logistic regression framework above. Similar to the concentration index, this alternative summary measure uses data across the entire sample, but examines absolute, rather than relative, inequality [23]. We used Stata v.13 for all analyses [24].…”

Section: Methodsmentioning

confidence: 99%

Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries

Palafox

McKee

Balabanova

et al. 2016

Int J Equity Health

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BackgroundEffective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household’s ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study.MethodsA cross-section of 163,397 adults aged 35 to 70 years were recruited from 661 urban and rural communities in selected low-, middle- and high-income countries (complete data for this analysis from 151,619 participants). Using blood pressure measurements, self-reported health and household data, concentration indices adjusted for age, sex and urban-rural location, we estimate the magnitude of wealth-related inequalities in the levels of hypertension awareness, treatment, and control in each of the 21 country samples.ResultsOverall, the magnitude of wealth-related inequalities in hypertension awareness, treatment, and control was observed to be higher in poorer than in richer countries. In poorer countries, levels of hypertension awareness and treatment tended to be higher among wealthier households; while a similar pro-rich distribution was observed for hypertension control in countries at all levels of economic development. In some countries, hypertension awareness was greater among the poor (Sweden, Argentina, Poland), as was treatment (Sweden, Poland) and control (Sweden).ConclusionInequality in hypertension management outcomes decreased as countries became richer, but the considerable variation in patterns of wealth-related inequality - even among countries at similar levels of economic development - underscores the importance of health systems in improving hypertension management for all. These findings show that some, but not all, countries, including those with limited resources, have been able to achieve more equitable management of hypertension; and strategies must be tailored to national contexts to achieve optimal impact at population level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0478-6) contains supplementary material, which is available to authorized users.

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Socioeconomic inequality in neonatal mortality in countries of low and middle income: a multicountry analysis

Abstract: Canadian Institutes of Health Research.

Cited by 107 publications

References 25 publications

Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis

Changes in Socio-Economic Inequality in Neonatal Mortality in Iran Between 1995-2000 and 2005-2010: An Oaxaca Decomposition Analysis

The persistent caste divide in India’s infant mortality: A study of Dalits (ex-untouchables), Adivasis (indigenous peoples), Other Backward Classes, and forward castes

Wealth and cardiovascular health: a cross-sectional study of wealth-related inequalities in the awareness, treatment and control of hypertension in high-, middle- and low-income countries

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