1214Coverage of maternal and child health in slums, rural and urban areas from 42 countries

Abstract

Abstract Background Rural populations are traditionally considered to have the lowest coverage on health interventions, but little is known about urban slums. Our aim was to analyse inequalities on the composite coverage index (CCI) – a weighted average of eight interventions on reproductive health, antenatal and delivery care, immunization and management of illnesses – according to place of residence in low- and middle-income countries. Methods We analysed the most recent Demographic and Health Surveys (2006-2018) from 42 countries. We estimated the CCI coverage according to the classification of the clusters women and children were living in (urban non-slums; urban slums; or rural areas). Slums were defined as clusters where at least 75% of the households did not have at least two of the following characteristics: access to improved water, access to basic sanitation, solid floor material, and sufficient rooms for sleeping. Results The CCI coverage ranged from 24% to 86% (median 63%), being higher in urban non-slums for all 42 countries. In 14 countries, the lowest CCI coverage was found in slums. The main drivers of the lowest estimates in slums were the coverage of care seeking for pneumonia, family planning, measles and DPT immunization, which were respectively 51%, 25%, 19%, and 15% lower in slums compared to rural areas. Conclusions It is important that public policies are designed in order to prioritise the urban poor populations, aiming to achieve an equitable coverage of essential health interventions. Key messages We studied a novel inequality dimension using national standardised surveys, expanding the assessment of the health situation according to the place of residence beyond a dichotomous approach (urban/rural). Investigating maternal and child health conditions in urban slums – a group that is often marginalised in urban areas – is very important to support the design of public policies that focus on those most in need.