Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries
Equity in maternal, newborn, and child health interventions in Countdown to 2015: a retrospective review of survey data from 54 countries
复制标题
DOI：
10.1016/s0140-6736(12)60113-5
复制
发表时间：
2012-03-31
期刊：
影响因子：
168.9
通讯作者：
Victora, Cesar G.
中科院分区：
文献类型：
--
作者：
Barros, Aluisio J. D.;Ronsmans, Carine;Victora, Cesar G.
背景2015年倒计时跟踪实现千年发展目标4和5的进展情况，特别强调国家内部的不平等。我们评估了如何在孕产妇，新生儿和儿童健康干预措施的不平等不同的干预措施和country.Methods我们重新分析了12孕产妇，新生儿和儿童健康干预措施的数据，从全国性的调查，在54倒计时国家之间的2000年1月1日，2008年12月31日。我们根据标准定义计算了干预措施的覆盖指标，并根据资产指数按财富五分位数对其进行了分层。我们评估的不平等与两个总结指数的绝对不平等和两个相对inequality.Findings熟练的助产士的覆盖面是最不公平的干预，根据所有四个总结指数，其次是四个或更多的产前保健访问。最公平的干预措施是尽早开始母乳喂养。乍得、尼日利亚、索马里、埃塞俄比亚、老挝和尼日尔是所审查的干预措施中最不公平的国家，其次是马达加斯加、巴基斯坦和印度。最公平的国家是乌兹别克斯坦和吉尔吉斯斯坦。基于社区的干预措施比在保健设施提供的干预措施分布更均匀。对于所有的干预措施，国家之间的覆盖率的变化是最贫穷的比最富有的individuals.Interpretation更大，我们注意到干预措施和国家之间的覆盖率水平有很大的差异。最不公平的干预措施应得到关注，以确保惠及所有社会群体。在保健设施提供的干预措施需要具体的战略，以使国家最贫穷的人能够得到帮助。最不公平的国家需要作出更多努力，缩小最贫穷者与较富裕者之间的差距。
Background Countdown to 2015 tracks progress towards achievement of Millennium Development Goals (MDGs) 4 and 5, with particular emphasis on within-country inequalities. We assessed how inequalities in maternal, newborn, and child health interventions vary by intervention and country.Methods We reanalysed data for 12 maternal, newborn, and child health interventions from national surveys done in 54 Countdown countries between Jan 1, 2000, and Dec 31, 2008. We calculated coverage indicators for interventions according to standard definitions, and stratified them by wealth quintiles on the basis of asset indices. We assessed inequalities with two summary indices for absolute inequality and two for relative inequality.Findings Skilled birth attendant coverage was the least equitable intervention, according to all four summary indices, followed by four or more antenatal care visits. The most equitable intervention was early initation of breastfeeding. Chad, Nigeria, Somalia, Ethiopia, Laos, and Niger were the most inequitable countries for the interventions examined, followed by Madagascar, Pakistan, and India. The most equitable countries were Uzbekistan and Kyrgyzstan. Community-based interventions were more equally distributed than those delivered in health facilities. For all interventions, variability in coverage between countries was larger for the poorest than for the richest individuals.Interpretation We noted substantial variations in coverage levels between interventions and countries. The most inequitable interventions should receive attention to ensure that all social groups are reached. Interventions delivered in health facilities need specific strategies to enable the countries' poorest individuals to be reached. The most inequitable countries need additional efforts to reduce the gap between the poorest individuals and those who are more affluent.