Ethnic group inequalities in coverage with reproductive, maternal and child health interventions: cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries
Ethnic group inequalities in coverage with reproductive, maternal and child health interventions: cross-sectional analyses of national surveys in 16 Latin American and Caribbean countries
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DOI：
10.1016/s2214-109x(18)30300-0
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发表时间：
2018-08-01
影响因子：
34.3
通讯作者：
Victora, Cesar G.
中科院分区：
文献类型：
--
作者：
Mesenburg, Marilia Arndt;Restrepo-Mendez, Maria Clara;Victora, Cesar G.
拉丁美洲和加勒比人口包括三个主要族裔群体：土著人民、非洲人后裔和欧洲人后裔。我们通过生殖、孕产妇、新生儿和儿童健康干预调查了这些群体在人口覆盖率方面的种族不平等。方法：我们分析了2004年至2015年在拉丁美洲和加勒比地区进行的16项具有全国代表性的标准化调查，这些调查提供了有关种族或代理指标（家庭语言或肤色）以及生殖、孕产妇、新生儿和儿童健康干预措施覆盖率的信息。我们选择了四个结果：现代避孕的覆盖率，产前保健的覆盖率（定义为四次或更多的产前检查），以及15-49岁妇女的熟练助产士；在12-23个月的儿童中接种三剂白喉-百日咳-破伤风（DPT3）疫苗。我们根据妇女和儿童自述的种族或语言将其分为土著、非洲人后裔或其他祖先（参照组）。中介变量包括财富五分位数（基于家庭资产指数）、女性教育和城乡居住。我们使用泊松回归计算粗覆盖率和调整覆盖率。不同国家的种族差异很大。在大多数国家，土著妇女的现代避孕（中位数覆盖率0.82,IQR 0.66-0.92）、产前护理（0.86,0.75-0.94）和熟练助产士（0.75,0.68-0.92）的覆盖率低于参照组。只有三个国家（尼加拉瓜、巴拿马和巴拉圭）在土著群体和参考群体之间DPT3覆盖率方面存在显著差距。在对财富、教育和居住地进行调整后，这种差异有所减弱，但仍然存在。在大多数国家，非洲裔妇女和儿童的覆盖率与参照组相似。土著妇女的低覆盖率是普遍存在的，不能仅仅用财富、教育或居住地的差异来解释。在社区层面提供的干预措施（如疫苗）比那些需要获得服务（如助产）的干预措施显示出更小的不平等。定期监测族裔不平等现象对于评价旨在纳入少数民族的现有倡议和规划有效的多部门政策和方案至关重要。版权所有(C) 2018作者。Elsevier Ltd.出版。这是一篇基于CC BY 4.0许可的开放获取文章。
Background Latin American and Caribbean populations include three main ethnic groups: indigenous people, people of African descent, and people of European descent. We investigated ethnic inequalities among these groups in population coverage with reproductive, maternal, newborn, and child health interventions.Methods We analysed 16 standardised, nationally representative surveys carried out from 2004 to 2015 in Latin America and the Caribbean that provided information on ethnicity or a proxy indicator (household language or skin colour) and on coverage of reproductive, maternal, newborn, and child health interventions. We selected four outcomes: coverage with modern contraception, antenatal care coverage (defined as four or more antenatal visits), and skilled attendants at birth for women aged 15-49 years; and coverage with three doses of diphtheria-pertussis-tetanus (DPT3) vaccine among children aged 12-23 months. We classified women and children as indigenous, of African descent, or other ancestry (reference group) on the basis of their self-reported ethnicity or language. Mediating variables included wealth quintiles (based on household asset indices), woman's education, and urban-rural residence. We calculated crude and adjusted coverage ratios using Poisson regression.Findings Ethnic gaps in coverage varied substantially from country to country. In most countries, coverage with modern contraception (median coverage ratio 0.82, IQR 0.66-0.92), antenatal care (0.86, 0.75-0.94), and skilled birth attendants (0.75, 0.68-0.92) was lower among indigenous women than in the reference group. Only three countries (Nicaragua, Panama, and Paraguay) showed significant gaps in DPT3 coverage between the indigenous and the reference groups. The differences were attenuated but persisted after adjustment for wealth, education, and residence. Women and children of African descent showed similar coverage to the reference group in most countries.Interpretation The lower coverage levels for indigenous women are pervasive, and cannot be explained solely by differences in wealth, education, or residence. Interventions delivered at community level-such as vaccines-show less inequality than those requiring access to services, such as birth attendance. Regular monitoring of ethnic inequalities is essential to evaluate existing initiatives aimed at the inclusion of minorities and to plan effective multisectoral policies and programmes. Copyright (C) 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.