There are substantial disparities in mortality between rich and poor children in developing countries. As a result, there is a call for explicitly pro-poor health programming in efforts to reach the child health Millennium Development Goals.
To estimate the contribution made by pro-poor health policy to reduction in wealth disparities in under-5 mortality.
An ecological, cross-sectional analysis was performed using Demographic and Health Survey data from 47 developing countries. Multivariate analysis was used to estimate the association between government health expenditure, the wealth distribution of two essential child health services (concentration indices of immunisation and treatment for acute respiratory infection) and aggregate under-5 mortality, as well as two measures of poor-rich equity in mortality outcomes-the quintile ratio and the concentration index of under-5 mortality-while confounders were controlled for.
Lower concentration (more pro-poor) indices for immunisation and treatment for acute respiratory infection were found to be associated with a reduction in inequity in under-5 mortality to the benefit of the poor. Government health expenditures were associated with lower overall national mortality reductions but had no effect on equity of mortality outcomes.
Redistributive health policies that promote pro-poor distribution of health services may reduce the gap in under-5 mortality between rich and poor in low-income and middle-income countries. To ensure that the poor gain from the current efforts to reach the Millennium Development Goals, essential child health services should explicitly target the poor. Failing that, the gains from these services will tend to accrue to the wealthier children in countries, magnifying inequalities in mortality.
"Increased attention has recently been given to economic disparities in health status, health service coverage, and their impact on health improvements in developing countries [1-5]. In these countries, children from poor families have higher risk of death than those from rich families, but paradoxically, rich families are generally the first to take advantage of health interventions that are not aggressively targeted to the poor [1,6,7]. "
[Show abstract][Hide abstract] ABSTRACT: Global health equity strategists have previously focused much on differences across countries. At first glance, the global health gap in health status appears to result primarily from disparities between the developing and developed regions. We examine how much of this disparity could be attributed to within-country disparities in developing nations.
We used data from Demographic and Health Surveys conducted between 1995 and 2010 in 67 developing countries. Using a population attributable risk approach, we computed the proportion of global under-five mortality gap and the absolute under-five deaths that would be reduced if the under-five mortality rate in each of these 67 countries was lowered to the level of the top 10% economic group in each country. As a sensitivity check, we also conducted comparable calculations replacing the top 10% with the top 5% and with the top 20%.
In 2007, approximately 6.6 million under-five deaths were observed in the 67 countries used in the analysis. This could be reduced to only 600,000 deaths if these countries had the same under-five mortality rate as developed countries. If the under-five mortality rate in developing countries was lowered to the rate among the top 10% economic group in those same each of these countries, under-five deaths would be reduced to 3.7 million. This corresponds to a 48% reduction in the global mortality gap and 2.9 million under-five deaths averted. Using cutoff points of top 5% and top 20% economic groups showed reduction of 37% and 56% respectively in the global mortality gap. With these cutoff points, respectively 2.3 and 3.4 million deaths would be averted.
Under-five mortality disparities within developing countries account for roughly half of the global gap between developed and developing countries. Thus, within-country inequities deserve as much consideration as do inequalities between the world's developing and developed regions.
BMC Public Health 03/2014; 14(1):216. DOI:10.1186/1471-2458-14-216 · 2.26 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To our knowledge, the present study provides a first time assessment of the contributions of socioeconomic determinants of immunization coverage in India using the recent National Family Health Survey data. Measurement of socioeconomic inequalities in health and health care, and understanding the determinants of such inequalities in terms of their contributions, are critical for health intervention strategies and for achieving equity in health care. A decomposition approach is applied to quantify the contributions from socio-demographic factors to inequality in immunization coverage. The results reveal that poor household economic status, mother's illiteracy, per capita state domestic product and proportion of illiterate at the state level is systematically related to 97% of predictable socioeconomic inequalities in full immunization coverage at the national level. These patterns of evidence suggest the need for immunization strategies targeted at different states and towards certain socioeconomic determinants as pointed out above in order to reduce socioeconomic inequalities in immunization coverage.
JEL Classification: I10, I12
[Show abstract][Hide abstract] ABSTRACT: Despite high rates of early childbearing, maternal mortality, and under-five mortality, little is known about factors that affect access of teenage mothers to maternal and child health (MCH) services in Niger. This paper explores potential factors associated with the utilization of MCH care services by adolescent mothers. Using the third wave of the Niger demographic and health survey (NDHS) 2006, we estimate three multivariate logistic regression models to assess individual characteristics associated with the utilization of antenatal care (ANC) and safe delivery care services among adolescent women, as well as full immunization received by children born to adolescent mothers. The analytical sample includes 934 adolescent mothers out of 1,835 respondents aged 15-19, and within this group, 493 mother-child dyads for children aged 12-59 months. Possessing any level of education was found associated with the increased use of all three selected MCH services, while urban residence and higher income were associated with the increased use of two of three MCH services studied. Higher birth order plus a birth interval more than 2 years for the most recent birth appeared associated with the lower probability of antenatal care visits and safe delivery care. This study finds that women who attended at least four ANC visits were more likely to experience safe delivery care, and the children whose mothers had safe delivery care were more likely to receive full immunization. Therefore, an effective program should be designed to promote a continuum of MCH care with special attention to adolescent women who are uneducated, poor and residing in rural areas.
Maternal and Child Health Journal 06/2013; 18(3). DOI:10.1007/s10995-013-1276-z · 2.24 Impact Factor
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