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3. Going deeper with health equity measurement: how much more can surveys reveal about inequalities in health intervention coverage and mortality in Zambia?

Author

Blanchard, Andrea K., Jacobs, Choolwe, Musukuma, Mwiche, Chooye, Ovost, Sikapande, Brivine, Michelo, Charles, Boerma, Ties, Wehrmeister, Fernando C., and University of Manitoba

Subjects
intervention coverage, inequality measurement, RMNCH, child mortality, Reproductive, Maternal, Newborn and Child Health, health equity, Demographic Health Surveys
Abstract

Background Although Zambia has achieved notable improvements in reproductive, maternal, newborn and child health (RMNCH), continued efforts to address gaps are essential to reach the Sustainable Development Goals by 2030. Research to better uncover who is being most left behind with poor health outcomes is crucial. This study aimed to understand how much more demographic health surveys can reveal about Zambia’s progress in reducing inequalities in under-five mortality rates and RMNCH intervention coverage. Methods Using four nationally-representative Zambia Demographic Health Surveys (2001/2, 2007, 2013/14, 2018), we estimated under-five mortality rates (U5MR) and RMNCH composite coverage indices (CCI) comparing wealth quintiles, urban‐rural residence and provinces. We further used multi-tier measures including wealth deciles and double disaggregation between wealth and region (urban residence, then provinces). These were summarised using slope indices of inequality, weighted mean differences from overall mean, Theil and concentration indices. Results Inequalities in RMNCH coverage and under-five mortality narrowed between wealth groups, residence and provinces over time, but in different ways. Comparing measures of inequalities over time, disaggregation with multiple socio-economic and geographic stratifiers was often valuable and provided additional insights compared to conventional measures. Wealth quintiles were sufficient in revealing mortality inequalities compared to deciles, but comparing CCI by deciles provided more nuance by showing that the poorest 10% were left behind by 2018. Examining wealth in only urban areas helped reveal closing gaps in under-five mortality and CCI between the poorest and richest quintiles. Though challenged by lower precision, wealth gaps appeared to close in every province for both mortality and CCI. Still, inequalities remained higher in provinces with worse outcomes. Conclusions Multi-tier equity measures provided similarly plausible and precise estimates as conventional measures for most comparisons, except mortality among some wealth deciles, and wealth tertiles by province. This suggests that related research could readily use these multi-tier measures to gain deeper insights on inequality patterns for both health coverage and impact indicators, given sufficient samples. Future household survey analyses using fit-for-purpose equity measures are needed to uncover intersecting inequalities and target efforts towards effective coverage that will leave no woman or child behind in Zambia and beyond.

Published
2023

5. Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services

Author

Amouzou, Agbessi, primary, Maïga, Abdoulaye, additional, Faye, Cheikh Mbacké, additional, Chakwera, Samuel, additional, Melesse, Dessalegn Y, additional, Mutua, Martin Kavao, additional, Thiam, Sokhna, additional, Abdoulaye, Idrissa Boukary, additional, Afagbedzi, Seth Kwaku, additional, Ag Iknane, Akory, additional, Ake-Tano, Odile Sassor, additional, Akinyemi, Joshua O, additional, Alegana, Victor, additional, Alhassan, Yakubu, additional, Sam, Arinaitwe Emma, additional, Atweam, Dominic Kwabena, additional, Bajaria, Shraddha, additional, Bawo, Luke, additional, Berthé, Mamadou, additional, Blanchard, Andrea Katryn, additional, Bouhari, Hamissou Alaji, additional, Boulhassane, Ousmane Maimouna Ali, additional, Bulawayo, Maio, additional, Chooye, Ovost, additional, Coulibaly, Amed, additional, Diabate, Mamatou, additional, Diawara, Fatou, additional, Esleman, Ousman, additional, Gajaa, Mulugeta, additional, Garba, Kamil Halimatou Amadou, additional, Getachew, Theodros, additional, Jacobs, Choolwe, additional, Jacobs, George P, additional, James, Femi, additional, Jegede, Ayodele S, additional, Joachim, Catherine, additional, Kananura, Rornald Muhumuza, additional, Karimi, Janette, additional, Kiarie, Helen, additional, Kpebo, Denise, additional, Lankoandé, Bruno, additional, Lawanson, Akanni Olayinka, additional, Mahamadou, Yahaha, additional, Mahundi, Masoud, additional, Manaye, Tewabe, additional, Masanja, Honorati, additional, Millogo, Modeste Roch, additional, Mohamed, Abdoul Karim, additional, Musukuma, Mwiche, additional, Muthee, Rose, additional, Nabié, Douba, additional, Nyamhagata, Mukome, additional, Ogwal, Jimmy, additional, Orimadegun, Adebola, additional, Ovuoraye, Ajiwohwodoma, additional, Pongathie, Adama Sanogo, additional, Sable, Stéphane Parfait, additional, Saydee, Geetor S, additional, Shabini, Josephine, additional, Sikapande, Brivine Mukombwe, additional, Simba, Daudi, additional, Tadele, Ashenif, additional, Tadlle, Tefera, additional, Tarway-Twalla, Alfred K, additional, Tassembedo, Mahamadi, additional, Tehoungue, Bentoe Zoogley, additional, Terera, Ibrahim, additional, Traoré, Soumaïla, additional, Twalla, Musu P, additional, Waiswa, Peter, additional, Wondirad, Naod, additional, and Boerma, Ties, additional

Published
2022
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6. Trends and Inequalities in Maternal and Newborn Health Services for Unplanned Settlements of Lusaka City, Zambia.

Author

Jacobs, Choolwe, Musukuma, Mwiche, Hamoonga, Raymond, Sikapande, Brivine, Chooye, Ovost, Wehrmeister, Fernando C., Michelo, Charles, and Blanchard, Andrea K.

Abstract

Living conditions and other factors in urban unplanned settlements present unique challenges for improving maternal and newborn health (MNH), yet MNH inequalities associated with such challenges are not well understood. This study examined trends and inequalities in coverage of MNH services in the last 20 years in unplanned and planned settlements of Lusaka City, Zambia. Geospatial information was used to map Lusaka’s settlements and health facilities. Zambia Demographic Health Surveys (ZDHS 2001, 2007, 2013/2014, and 2018) were used to compare antenatal care (ANC), institutional delivery, and Cesarean section (C-section) coverage, and neonatal mortality rates between the poorer 60% and richer 40% households. Health Management Information System (HMIS) data from 2018 to 2021 were used to compute service volumes and coverage rates for ANC1 and ANC4, and institutional delivery and C-sections by facility level and type in planned and unplanned settlements. Although the correlation is not exact, our data analysis showed close alignment; and thus, we opted to use the 60% poorer and 40% richer groups as a proxy for households in unplanned versus planned settlements. Unplanned settlements were serviced by primary centers or first-level hospitals. ZDHS findings show that by 2018, at least one ANC visit and institutional delivery became nearly universal throughout Lusaka, but early and four or more ANC visits, C-sections, and neonatal mortality rates remained worse among poorer than richer women in ZDHS. In HMIS, ANC and institutional delivery volumes were highest in public facilities, especially in unplanned settlements. The volume of C-sections was much greater within facilities in planned than unplanned settlements. Our study exposed persistent gaps in timing and use of ANC and emergency obstetric care between unplanned and planned communities. Closing such gaps requires strengthening outreach early and consistently in pregnancy and increasing emergency obstetric care capacities and referrals to improve access to important MNH services for women and newborns in Lusaka’s unplanned settlements. [ABSTRACT FROM AUTHOR]

Published
2024
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