Abstract
BackgroundMaternal mortality remains high in sub-Saharan African countries, including Guinea. Skilled birth attendance (SBA) is one of the crucial interventions to avert preventable obstetric complications and related maternal deaths. However, within-country inequalities prevent a large proportion of women from receiving skilled birth attendance. Scarcity of evidence related to this exists in Guinea. Hence, this study investigated the magnitude and trends in socioeconomic and geographic-related inequalities in SBA in Guinea from 1999 to 2016 and neonatal mortality rate (NMR) between 1999 and 2012.MethodsWe derived data from three Guinea Demographic and Health Surveys (1999, 2005 and 2012) and one Guinea Multiple Indicator Cluster Survey (2016). For analysis, we used the 2019 updated WHO Health Equity Assessment Toolkit (HEAT). We analyzed inequalities in SBA and NMR using Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D) and Ratio (R). These summary measures were computed for four equity stratifiers: wealth, education, place of residence and subnational region. We computed 95% Uncertainty Intervals (UI) for each point estimate to show whether or not observed SBA inequalities and NMR are statistically significant and whether or not disparities changed significantly over time.ResultsA total of 14,402 for SBA and 39,348 participants for NMR were involved. Profound socioeconomic- and geographic-related inequalities in SBA were found favoring the rich (PAR = 33.27; 95% UI: 29.85–36.68), educated (PAR = 48.38; 95% UI: 46.49–50.28), urban residents (D = 47.03; 95% UI: 42.33–51.72) and regions such as Conakry (R = 3.16; 95% UI: 2.31–4.00). Moreover, wealth-driven (PAF = -21.4; 95% UI: −26.1, −16.7), education-related (PAR = -16.7; 95% UI: −19.2, −14.3), urban-rural (PAF = -11.3; 95% UI: −14.8, −7.9), subnational region (R = 2.0, 95% UI: 1.2, 2.9) and sex-based (D = 12.1, 95% UI; 3.2, 20.9) inequalities in NMR were observed between 1999 and 2012. Though the pattern of inequality in SBA varied based on summary measures, both socioeconomic and geographic-related inequalities decreased over time.ConclusionsDisproportionate inequalities in SBA and NMR exist among disadvantaged women such as the poor, uneducated, rural residents, and women from regions like Mamou region. Hence, empowering women through education and economic resources, as well as prioritizing SBA for these disadvantaged groups could be key steps toward ensuring equitable SBA, reduction of NMR and advancing the health equity agenda of “no one left behind.”
Highlights
Maternal mortality remains high in sub-Saharan African countries, including Guinea
Both Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Survey (MICS) collect nationally representative, wide-ranging data related to health, education and mortality which can be used for tracking progress toward the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) [29, 30]
For all DHS and MICS surveys, a two-stage stratified cluster sampling technique was used. This is targeted to provide adequate representation of urban and rural settings as well as the eight domains corresponding to the five administrative regions in Guinea in 1999 (i.e., Lower Guinea, Central Guinea, Upper Guinea, Forest Guinea and Conakry) and eight regions for the rest three years of surveys (2005, 2012 and 2016) (i.e., Boké, Conakry, Faranah, Kankan, Kindia, Labé, Mamou and N’Zérékoré), for which we have an estimate for all key indicators [29, 30]
Summary
Skilled birth attendance (SBA) is one of the crucial interventions to avert preventable obstetric complications and related maternal deaths. Sub-Saharan Africa (SSA) accounts for 68% of daily maternal deaths, which is approximately 533 maternal deaths per 100,000 live births, or 200,000 maternal deaths a year [4]. In Guinea, though considerable improvements have occurred, it is still high with a maternal mortality ratio (MMR) of 550 per 100,000 live births in 2016 [5]. Giving birth with the help of skilled birth attendants (SBAs) will assuage maternal and perinatal mortality by averting or early management of most obstetric complications [10]. Between the years 1990 and 2016, neonatal mortality rates (NMRs) declined (i.e., from 37 to 19 deaths per 1000 live births). Tremendous decline in neonatal mortality can occur through SBA, because that prevents 40–70% of newborn deaths [16,17,18,19]
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