Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries
Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries
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DOI：
10.1016/s0140-6736(08)60560-7
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发表时间：
2008-04-12
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：
Boerma, J. Ties;Bryce, Jennifer;Victora, Cesar G.
如果要实现千年发展目标（MDG）4和5，就必须扩大关键孕产妇、新生儿和儿童健康干预措施的覆盖面。我们通过一个总结指数评估了一组关键干预措施的覆盖率的公平性和趋势，以提供对过去绩效和进展前景的全面了解。方法1990 - 2006年期间，在孕产妇、新生儿和儿童生存倒计时到2015年倡议中，来自54个国家的家庭调查数据被用来计算基于四个干预领域的总覆盖指数：计划生育、孕产妇和新生儿护理、免疫接种和患病儿童的治疗。在计算指数时，这四个领域的权重相等。标准的措施，以评估目前的水平和趋势的覆盖差距措施的财富quintile. Findings的覆盖差距的整体规模范围从不到20%，在塔吉克斯坦和秘鲁超过70%，在埃塞俄比亚和乍得，平均43%，最近的调查中的54个国家。注意到国家间的巨大差异，最贫穷的五分之一人口的国家平均覆盖率差距为54%，最富有的为29%。最贫穷和最富有的人在孕产妇和新生儿健康干预方面的差异最大，在免疫接种方面的差异最小。在进行了一次以上调查的40个国家中，自1990年代初以来，覆盖率差距平均每年减少0.9个百分点。1995年后，只有三个国家的年下降率超过2个百分点：柬埔寨、莫桑比克和尼泊尔。随着时间的推移，国家的不平等模式非常持久，只有从最不平等开始逐渐变化在覆盖率差距超过40%的国家，（最富裕国家的差距不成比例地小），线性模式和底层不平等尽管大多数倒计时国家自1990年以来取得了逐步进展，关键干预措施的覆盖率差距仍然很大，在大多数这类国家，下降速度需要增加一倍以上，才能达到千年发展目标4和5所需的这些和其他干预措施的覆盖率水平。一般而言，国内的不平等模式是一致的，即使有变化，也是逐渐变化的，这对干预措施的针对性产生了影响。
Background Increasing the coverage of key maternal, newborn, and child health interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. We have assessed equity and trends in coverage rates of a key set of interventions through a summary index, to provide overall insight into past performance and progress perspectives.Methods Data from household surveys from 54 countries in the Countdown to 2015 for Maternal, Newborn and Child Survival initiative during 1990-2006 were used to compute an aggregate coverage index based on four intervention areas: family planning, maternal and newborn care, immunisation, and treatment of sick children. The four areas were given equal weight in the computation of the index. Standard measures were applied to assess current levels and trends in the coverage gap measure by wealth quintile.Findings The overall size of the coverage gap ranged from less than 20% in Tajikistan and Peru to over 70% in Ethiopia and Chad, with a mean of 43% for the most recent surveys in the 54 countries. Large intracountry differences were noted, with a country mean coverage gap of 54% for the poorest quintiles of the population and 29% for the wealthiest. Differences between the poorest and the wealthiest were largest for the maternal and newborn health intervention area and smallest for immunisation. In 40 countries with more than one survey, the coverage gap had decreased by an average of 0.9 percentage points per year since the early 1990s. Declines greater than 2 percentage points per year were seen in only three countries after 1995: Cambodia, Mozambique, and Nepal. Country inequity patterns were remarkably persistant over time, with only gradual changes from top inequity (disproportionately smaller gap for the wealthiest) in countries with coverage gaps exceeding 40%, to linear patterns and bottom inequity (disproportionately greater gap for the poorest) in surveys with gaps below 40%.Interpretation Despite most Countdown countries having made gradual progress since 1990, coverage gaps for key interventions remain wide and, in most such countries, the pace of decline needs to be more than doubled to reach levels of coverage of these and other interventions needed in the context of MDG 4 and 5. In general, in-country patterns of inequality are consistant and change only gradually if at all, which has implications for the targeting of interventions.