Coverage and equity of maternal and newborn health care in rural Nigeria, Ethiopia and India.

Autor:	Marchant T; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria Tanya.Marchant@lshtm.ac.uk., Beaumont E; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Makowiecka K; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Berhanu D; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Tessema T; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Gautham M; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Singh K; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Umar N; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Usman AU; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Tomlin K; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Cousens S; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Allen E; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria., Schellenberg JA; Faculties of Infectious and Tropical Diseases (Marchant, Berhanu, Gautham, Umar, Armstrong Schellenberg) and of Epidemiology and Population Health (Beaumont, Makowiecka, Tomlin, Cousens, Allen), London School of Hygiene & Tropical Medicine, London, UK; Ethiopian Public Health Institute (Berhanu) and JaRco Consulting (Tessema), Addis Ababa, Ethiopia; Sambodhi Research and Communications Pvt. Ltd. (Singh), New Delhi, India; Data Research and Mapping Consult (Usman), Abuja, Nigeria.
Jazyk:	angličtina
Zdroj:	CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne [CMAJ] 2019 Oct 28; Vol. 191 (43), pp. E1179-E1188.
DOI:	10.1503/cmaj.190219
Abstrakt:	Background: Despite progress toward meeting the Sustainable Development Goals, a large burden of maternal and neonatal mortality persists for the most vulnerable people in rural areas. We assessed coverage, coverage change and inequity for 8 maternal and newborn health care indicators in parts of rural Nigeria, Ethiopia and India. Methods: We examined coverage changes and inequity in 2012 and 2015 in 3 high-burden populations where multiple actors were attempting to improve outcomes. We conducted cluster-based household surveys using a structured questionnaire to collect 8 priority indicators, disaggregated by relative household socioeconomic status. Where there was evidence of a change in coverage between 2012 and 2015, we used binomial regression models to assess whether the change reduced inequity. Results: In 2015, we interviewed women with a birth in the previous 12 months in Gombe, Nigeria ( n = 1100 women), Ethiopia ( n = 404) and Uttar Pradesh, India ( n = 584). Among the 8 indicators, 2 positive coverage changes were observed in each of Gombe and Uttar Pradesh, and 5 in Ethiopia. Coverage improvements occurred equally for all socioeconomic groups, with little improvement in inequity. For example, in Ethiopia, coverage of facility delivery almost tripled, increasing from 15% (95% confidence interval [CI] 9%-25%) to 43% (95% CI 33%-54%). This change was similar across socioeconomic groups ( p = 0.2). By 2015, the poorest women had about the same facility delivery coverage as the least poor women had had in 2012 (32% and 36%, respectively), but coverage for the least poor had increased to 60%. Interpretation: Although coverage increased equitably because of various community-based interventions, underlying inequities persisted. Action is needed to address the needs of the most vulnerable women, particularly those living in the most rural areas. Competing Interests: Competing interests: None declared. (© 2019 Joule Inc. or its licensors.)
Databáze:	MEDLINE
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