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Inequalities in maternal health care utilization in sub-saharan african countries: a multiyear and multi-country analysis.

Alam N, Hajizadeh M, Dumont A, Fournier P - PLoS ONE (2015)

Bottom Line: 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.In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality.Relative inequality declined overtime in countries which made progress towards reducing maternal mortality.

View Article: PubMed Central - PubMed

Affiliation: Research Centre of the University of Montreal Hospital (CR-CHUM), Montreal, Quebec, Canada; School of Public Health, University of Montreal, Montreal, Canada.

ABSTRACT
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.

No MeSH data available.


Maternal mortality ratio (per 100,000 live births) in selected SSA countries: 1990–2010.
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pone.0120922.g001: Maternal mortality ratio (per 100,000 live births) in selected SSA countries: 1990–2010.

Mentions: There were two different trends in the MMR across the six selected SSA countries over the period between 1990 and 2010 (Fig. 1). The MMR declined in Ethiopia, Madagascar and Uganda over the last two decades whereas the MMR increased or plateaued during the same period in Zimbabwe, Zambia and Cameroon. Ethiopia witnessed a more dramatic decline in maternal mortality over this time period, with an MMR of 950/per 100,000 live births in 1990 and 350/per 100,000 live births in 2010. By contrast, the MMR in Zimbabwe increased from 470/per 100,000 deaths in 1990 to 570/per 100,000 deaths in 2010.


Inequalities in maternal health care utilization in sub-saharan african countries: a multiyear and multi-country analysis.

Alam N, Hajizadeh M, Dumont A, Fournier P - PLoS ONE (2015)

Maternal mortality ratio (per 100,000 live births) in selected SSA countries: 1990–2010.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4390337&req=5

pone.0120922.g001: Maternal mortality ratio (per 100,000 live births) in selected SSA countries: 1990–2010.
Mentions: There were two different trends in the MMR across the six selected SSA countries over the period between 1990 and 2010 (Fig. 1). The MMR declined in Ethiopia, Madagascar and Uganda over the last two decades whereas the MMR increased or plateaued during the same period in Zimbabwe, Zambia and Cameroon. Ethiopia witnessed a more dramatic decline in maternal mortality over this time period, with an MMR of 950/per 100,000 live births in 1990 and 350/per 100,000 live births in 2010. By contrast, the MMR in Zimbabwe increased from 470/per 100,000 deaths in 1990 to 570/per 100,000 deaths in 2010.

Bottom Line: 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.In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality.Relative inequality declined overtime in countries which made progress towards reducing maternal mortality.

View Article: PubMed Central - PubMed

Affiliation: Research Centre of the University of Montreal Hospital (CR-CHUM), Montreal, Quebec, Canada; School of Public Health, University of Montreal, Montreal, Canada.

ABSTRACT
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.

No MeSH data available.