Inequalities in Maternal Health Care Utilization in Sub-Saharan African Countries: A Multiyear and Multi-Country Analysis

被引:88
作者
Alam, Nazmul [1 ,2 ]
Hajizadeh, Mohammad [3 ]
Dumont, Alexandre [4 ]
Fournier, Pierre [1 ,2 ]
机构
[1] Univ Montreal Hosp CR CHUM, Res Ctr, Montreal, PQ, Canada
[2] Univ Montreal, Sch Publ Hlth, Montreal, PQ, Canada
[3] Dalhousie Univ, Sch Hlth Adm, Halifax, NS, Canada
[4] Univ Paris 05, Inst Dev Res, Paris, France
来源
PLOS ONE | 2015年 / 10卷 / 04期
关键词
EMERGENCY OBSTETRIC CARE; SERVICES; MORTALITY; ACCESS; BARRIERS; INTERVENTIONS; DETERMINANTS; INEQUITIES; BANGLADESH; SURVIVAL;
D O I
10.1371/journal.pone.0120922
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
To assess social inequalities in the use of antenatal care (ANC), facility based delivery (FBD), and modern contraception (MC) in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda) had <350 MMR in 2010 with >4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe) had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS) before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda), ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in countries which made progress towards reducing maternal mortality.
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页数:16
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