Inequitable Utilization of Neonatal Health Services in Southwest Ethiopia: The Effects of Socioeconomic Disparities

Abstract

Low levels of neonatal health services utilization and high neonatal deaths are often concentrated among socially and economically disadvantaged groups, especially in low-income countries. Therefore the aim of this study was to assess inequity in the use of neonatal health services in Southwest Ethiopia. A community-based cross-sectional study was conducted in 8 districts located in Jimma Zone, Southwest Ethiopia from 19 March to 28 April 2018. A total of 835 mothers were included in the study with systematic random sampling. Principal component analysis was conducted to develop wealth quintiles of the households. Equity in neonatal health services was measured using rate-ratio, concentration curve, concentration index, and analyzed by binary logistic regression. Neonates from richer families were 1.25 times more likely to use neonatal health services than the poorer households with a concentration index value of 0.07. Neonates from highly educated mothers have better used the services and the corresponding concentration index value of 0.03. Neonatal service utilization was 1.32 times higher in the highest wealth quintile in rural settings. Similarly, services delivered at health posts and hospitals were used 2.4 and 2 times more by the wealthy, whereas services given at health centers are more utilized by the poorest. Outputs of binary logistic regression analysis indicated that neonates from middle quintile wealth households were found to be better neonatal health service users [AOR_1.72, 95% CI: 1.04, 2.82]. Neonate born from a secondary school attended mother [AOR_3.56, 95% CI: 1.90, 6.69] were more likely to use neonatal health services. Neonatal health service utilization in Southwest Ethiopia is more common among neonates from richer households and more educated mothers. There is a big difference among the wealthy and poorer in a rural setting and among those who used health posts. Working on the social-determinants of health will facilitate eliminating inequity.

Inequality in child immunization coverage in Ethiopia: evidence from Expanded Program for Immunization coverage survey

“…Therefore, in this study equity analysis was conducted by using reliable, trusted, and comparable dataset rather than using other administrative, other surveys, and other international/national estimates of coverage. Some national and international studies have investigated the inequality of child vaccination, consequently, our result contradicted with a study conducted on wealth-based equity in child health services utilization implying that child health service utilization were equitable among poorest and richest (7,(12)(13)(14). Our finding for full vaccination coverage consistent with the report of other low-and middle-income countries (15,16), shown immunization coverage better-off wealth status more likely in vaccine use.…”

Measuring socioeconomic inequalities in postnatal health checks for newborns in Ethiopia: a decomposition analysis

“…The findings of the present study imply that the postnatal health check for newborns was concentrated among newborns with high socioeconomic status. Our study is comparable with the findings of the previous studies ( 12 , 20 , 21 ). However, the magnitude of pro-rich inequalities in postnatal health checks for newborns was not comparable with the previous studies.…”

“…Currently, the utilization of postnatal health care services is not fairly distributed in low and middle income countries, and it varies significantly on the basis of socioeconomic status ( 20 ). In Ethiopia, studies have described the existence of substantial inequality in the utilization of health services including postnatal health checks across socioeconomic groups ( 7 , 12 , 21 ). Findings from southwest Ethiopia highlighted that neonatal health service utilization was highly concentrated among newborns from educated mothers and households ( 21 ).…”

“…In Ethiopia, studies have described the existence of substantial inequality in the utilization of health services including postnatal health checks across socioeconomic groups ( 7 , 12 , 21 ). Findings from southwest Ethiopia highlighted that neonatal health service utilization was highly concentrated among newborns from educated mothers and households ( 21 ). Likewise, another research also found that the quality of postnatal newborn care is more prevalent among newborns from higher socioeconomic households ( 12 ).…”