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Background Widespread increases in facility delivery have not substantially reduced neonatal mortality in sub-Saharan Africa and South Asia over the past 2 decades. This may be due to poor quality care available in widely used primary care clinics. In this study, we examine the association between hospital delivery and neonatal mortality. Methods and findings We used an ecological study design to assess cross-sectional associations between the share of hospital delivery and neonatal mortality across country regions. Data were from the Demographic and Health Surveys from 2009 to 2018, covering 682,239 births across all regions. We assess the association between the share of facility births in a region that occurred in hospitals (versus lower-level clinics) and early (0 to 7 days) neonatal mortality per 1,000 births, controlling for potential confounders including the share of facility births, small at birth, maternal age, maternal education, urbanicity, antenatal care visits, income, region, and survey year. We examined changes in this association in different contexts of country income, global region, and urbanicity using interaction models. Across the 1,143 regions from 37 countries in sub-Saharan Africa and South Asia, 42%, 29%, and 28% of births took place in a hospital, clinic, and at home, respectively. A 10-percentage point higher share of facility deliveries occurring in hospitals was associated with 1.2 per 1,000 fewer deaths (p-value < 0.01; 95% CI: 0.82 to 1.60), relative to mean mortality of 22. Associations were strongest in South Asian countries, middle-income countries, and urban regions. The study's limitations include the inability to control for all confounding factors given the ecological and cross-sectional design and potential misclassification of facility levels in our data. Conclusions Regions with more hospital deliveries than clinic deliveries have reduced neonatal mortality. Increasing delivery in hospitals while improving quality across the health system may help to reduce high neonatal mortality., Author(s): Anna D. Gage 1,*, Günther Fink 2,3, John E. Ataguba 4,5, Margaret E. Kruk 1 Introduction Despite substantial increases in facility delivery in the past 2 decades, global declines [...]

This paper is part of the PLOS Universal Health Coverage Collection. This is the summary of the South Africa country case study. The full paper is available as Supporting Information [...]

Overweight and obesity in adult women contribute to deaths and disability from non-communicable diseases (NCDs) and obesity-related health problems in their offspring. Globally, overweight and obesity prevalence among women of childbearing age (WCBA) has increased, but associated socioeconomic inequality remains unclear. This study, therefore, assesses the changing patterns in the socioeconomic inequality in overweight and obesity among South African non-pregnant WCBA between 1998 and 2016. It uses data from the 1998 and 2016 Demographic and Health Surveys. Socioeconomic inequality in overweight and obesity was assessed using the concentration index (C). The index was decomposed to identify contributing factors to obesity and overweight inequalities. Factors contributing to changes in inequalities between 1998 and 2016 were assessed using the Oaxaca-type decomposition approach. Socioeconomic inequalities in overweight and obesity among WCBA in South Africa increased between 1998 (C of 0.02 and 0.06, respectively) and 2016 (C of 0.04 and 0.08, respectively). Socioeconomic status was the biggest contributor to overweight and obesity inequalities for both years. The Oaxaca-type decomposition showed that race and urban residence are major contributors to changes in overweight and obesity inequalities. Policies such as the current tax on sugar-sweetened beverages and subsidising fruits and vegetables, among others, are needed to prioritise WCBA, especially for those from disadvantaged socioeconomic backgrounds, in addressing inequalities in overweight and obesity in South Africa., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nglazi, Ataguba. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The changing food environment shifts peoples' eating behaviour toward unhealthy food, including ultra-processed food (UPF), leading to detrimental health outcomes like obesity. This study examines changes in socioeconomic inequalities in food consumption spending between 2005/06 and 2010/11 in South African households with women of childbearing age (15 to 49) (WCBA). Data come from the 2005/06 and 2010/11 Income and Expenditure Surveys. The distribution of spending according to the NOVA food classification system groupings (unprocessed or minimally processed foods, processed culinary ingredients, processed and UPF products) was analysed using standard methodologies. Changes in spending inequalities between 2005/06 and 2010/11 were assessed using the concentration index (C), while the factors explaining the changes in spending inequalities were identified using the Oaxaca decomposition approach. The Kakwani index (K) was used to assess progressivity. Results show that average real spending on all food categories, including UPF, increased between 2005/06 and 2010/11. Socioeconomic inequality in UPF consumption spending decreased (C = 0.498 in 2005/06 and C = 0.432 in 2010/11), and spending on processed foods (C = 0.248 in 2005/06 and C = 0.209 in 2010/11). Socioeconomic status, race, and urban residence contributed to overall socioeconomic inequality and changes in UPF consumption inequality between 2005/06 and 2010/11. Spending on all food categories was regressive in 2005/06 (K = -0.173 for UPF and -0.425 for processed foods) and 2010/11 (K = -0.192 for UPF and -0.418 for processed foods) because such spending comprises a larger share of poorer household's income than their wealthier counterparts. The government should address these contributors to inequality to mitigate the risks associated with UPF consumption, especially among less affluent households., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nglazi, Ataguba. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)