Access to skilled attendant at birth and the coverage of the third dose of diphtheria-tetanus-pertussis vaccine across 14 West African countries – an equity analysis

Alhassan, Jacob Albin Korem; Wariri, Oghenebrume; Onuwabuchi, Egwu; Mark, Godwin; Kwarshak, Yakubu Kevin; Dase, Eseoghene

doi:10.1186/s12939-020-01204-5

Cited by 6 publications

(5 citation statements)

References 21 publications

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“…In this study, we described economic-related inequalities in zero-dose children across 89 low-and middle-income countries. Our results indicate that widespread economicrelated inequalities to the detriment of the poorest countries, similar to previous multicountry analyses of inequalities in DTP3 coverage [19][20][21]. Our focus on zero-dose DTP prevalence, the flagship indicator of IA2030 and Gavi 5.0, yielded new insights into changes in inequality over time.…”

Section: Discussionsupporting

confidence: 82%

Economic-Related Inequalities in Zero-Dose Children: A Study of Non-Receipt of Diphtheria–Tetanus–Pertussis Immunization Using Household Health Survey Data from 89 Low- and Middle-Income Countries

et al. 2022

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Despite advances in scaling up new vaccines in low- and middle-income countries, the global number of unvaccinated children has remained high over the past decade. We used 2000–2019 household survey data from 154 surveys representing 89 low- and middle-income countries to assess within-country, economic-related inequality in the prevalence of one-year-old children with zero doses of diphtheria–tetanus–pertussis (DTP) vaccine. Zero-dose DTP prevalence data were disaggregated by household wealth quintile. Difference, ratio, slope index of inequality, concentration index, and excess change measures were calculated to assess the latest situation and change over time, by country income grouping for 17 countries with high zero-dose DTP numbers and prevalence. Across 89 countries, the median prevalence of zero-dose DTP was 7.6%. Within-country inequalities mostly favored the richest quintile, with 19 of 89 countries reporting a rich–poor gap of ≥20.0 percentage points. Low-income countries had higher inequality than lower–middle-income countries and upper–middle-income countries (difference between the median prevalence in the poorest and richest quintiles: 14.4, 8.9, and 2.7 percentage points, respectively). Zero-dose DTP prevalence among the poorest households of low-income countries declined between 2000 and 2009 and between 2010 and 2019, yet economic-related inequality remained high in many countries. Widespread economic-related inequalities in zero-dose DTP prevalence are particularly pronounced in low-income countries and have remained high over the previous decade.

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Section: Discussionsupporting

confidence: 82%

Economic-Related Inequalities in Zero-Dose Children: A Study of Non-Receipt of Diphtheria–Tetanus–Pertussis Immunization Using Household Health Survey Data from 89 Low- and Middle-Income Countries

et al. 2022

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“…Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions to prevent adverse pregnancy outcomes [ 7 ]. However, in many LMICs, access to SBA or EmONC services can be difficult due to several delays, especially for populations living in rural settings or urban slums where access to roads and means of transportation are suboptimal, rarely available, or unaffordable [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria

et al. 2021

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Access to quality emergency obstetric and newborn care (EmONC); having a skilled attendant at birth (SBA); adequate antenatal care; and efficient referral systems are considered the most effective interventions in preventing stillbirths. We determined the influence of travel time from mother’s area of residence to a tertiary health facility where women sought care on the likelihood of delivering a stillbirth. We carried out a prospective matched case-control study between 1st January 2019 and 31st December 2019 at the Federal Teaching Hospital Gombe (FTHG), Nigeria. All women who experienced a stillbirth after hospital admission during the study period were included as cases while controls were consecutive age-matched (ratio 1:1) women who experienced a live birth. We modelled travel time to health facilities. To determine how travel time to the nearest health facility and the FTHG were predictive of the likelihood of stillbirths, we fitted a conditional logistic regression model. A total of 318 women, including 159 who had stillborn babies (cases) and 159 age-matched women who had live births (controls) were included. We did not observe any significant difference in the mean travel time to the nearest government health facility for women who had experienced a stillbirth compared to those who had a live birth [9.3 mins (SD 7.3, 11.2) vs 6.9 mins (SD 5.1, 8.7) respectively, p = 0.077]. However, women who experienced a stillbirth had twice the mean travel time of women who had a live birth (26.3 vs 14.5 mins) when measured from their area of residence to the FTHG where deliveries occurred. Women who lived farther than 60 minutes were 12 times more likely of having a stillborn [OR = 12 (1.8, 24.3), p = 0.011] compared to those who lived within 15 minutes travel time to the FTHG. We have shown for the first time, the influence of travel time to a major tertiary referral health facility on the occurrence of stillbirths in an urban city in, northeast Nigeria.

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“…Despite the country’s oil wealth and abundant natural resources, the state of RMNCH services remains poor. Nigeria consistently accounts for the broadest equity gaps between the extreme subgroups of the equity dimension 7 22 93 94. Several studies have established that individual socio-demographic factors and some country-level determinants such as inadequate government health financing and funding of UHC, poor level of political commitment, weak health system, lack of policy implementation and enforcement, poor quality regulation, unsatisfactory data management and research, a deficit in health workforce and gender inequality influence the coverage of health services 55 95–98.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Nigeria recorded the highest number of under-5 pneumonia-related deaths in 2018, with 162 000 deaths 21. Despite Nigeria’s poor maternal and child health indices, studies have further highlighted the existence of inequalities among various subpopulations in the country 7 22–26…”

Section: Introductionmentioning

confidence: 99%

Insight into Nigeria’s progress towards the universal coverage of reproductive, maternal, newborn and child health services: a secondary data analysis

Mafiana

Shen

et al. 2022

BMJ Open

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ObjectiveThis study investigated the progress towards the universal coverage of reproductive, maternal, newborn and child health (RMNCH) services in Nigeria after universal health coverage (UHC) adoption.DesignA descriptive observational approach was used based on secondary data analysis. Representative data generated from publicly accessible databases and reports were used to describe the coverage trend and estimate the absolute inequality. Analysis was conducted using Excel and the WHO’s Health Equity Assessment Toolkit software.SettingThe study setting is Nigeria.ParticipantsAggregated health service coverage data of women aged 15–49 years and children under 5 years of age.Outcome measuresThe outcome of interest is the level of coverage of RMNCH services in Nigeria and the difference in equity gaps among subgroups before and after UHC adoption.ResultsThe RMNCH index increased by 6.4% points with a difference of 33.7% points to attain the minimum 80.0% target. The widest inequality was by economic status with the difference ranging from 21.9% points (95% CI 10.1% to 33.8%) to 56.3% points (95% CI 51.5% to 61.2%), Absolute Concentration Index from 3.5% points (95% CI 1.6% to 5.5%) to 11.3% points (95% CI 10.4% to 12.2%), Slope Index of Inequality from 23.1% points (95% CI 11.9% to 34.2%) to 65.5% points (95% CI 62.6% to 68.5%) and population attributable risk from 9.3% points (95% CI 7.3% to 11.4%) to 31.2% points (95% CI 29.0% to 33.3%). Among the indicators, three doses of diphtheria–tetanus–toxoid–pertussis immunisation had the widest absolute inequality across the subgroups.ConclusionThe poor coverage of RMNCH services in Nigeria and persistent inequalities pinpoint the need to investigate further the country-level determinant of RMNCH service coverage. In addition, it emphasises the need to formulate effective policies focusing on marginalised groups and improving resource allocation to ensure sustainable service coverage.

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Access to skilled attendant at birth and the coverage of the third dose of diphtheria-tetanus-pertussis vaccine across 14 West African countries – an equity analysis

Cited by 6 publications

References 21 publications

Economic-Related Inequalities in Zero-Dose Children: A Study of Non-Receipt of Diphtheria–Tetanus–Pertussis Immunization Using Household Health Survey Data from 89 Low- and Middle-Income Countries

Economic-Related Inequalities in Zero-Dose Children: A Study of Non-Receipt of Diphtheria–Tetanus–Pertussis Immunization Using Household Health Survey Data from 89 Low- and Middle-Income Countries

The influence of travel time to health facilities on stillbirths: A geospatial case-control analysis of facility-based data in Gombe, Nigeria

Insight into Nigeria’s progress towards the universal coverage of reproductive, maternal, newborn and child health services: a secondary data analysis

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