Abstract
BackgroundGlobally, progress in Maternal and Child Health (MCH) has been inconsistent, with several evidence showing both between and within country disparities in several RMNCH outcome measures. In this study, we aim to meta-analyse existing literature on association between three major equity stratifiers and a selection of RMNCH indicators.MethodsWe searched PubMed, Embase, Scopus databases and grey literatures from the WHO, UNICEF and World Bank publications. Using the PRISMA guidelines, we identified and reviewed studies from low and middle-income countries, that explored the effects of inequalities on RMNCH, with focus on studies that utilised data from a nationally representative survey. The review protocol was registered at the PROSPERO international prospective register of systematic reviews.ResultsA total of 28 studies were included in the meta-analysis. Results revealed the existence of marked inequality based on income levels, education and place of residence. The most significant level of disparity was with regards to unmet need for contraception and antenatal coverage. For both respective indicators, those with secondary or higher education were 6 times more likely to have better coverage, than those with lesser level of education; (odds ratio (OR) = 6.25 (95% confidence interval (CI) = 1.68-23.23; I2 = 98%, P = 0.006) and (OR = 6.17 (95% CI = 3.03-12.56; I2 = 97%, P < 0.00001) respectively. In contrast, the lowest inequality was in the completion of 3 doses of diphtheria, pertussis and tetanus vaccines (DPT3), those with primary or no education, were equally as likely as those with secondary or higher education to have received DPT3; (OR = 1.21, 95% CI = 0.34-4.27; I2 = 96%, P = 0.77).ConclusionsIn developing countries, maternal and child health coverage remains highly inequitable and assess to maternal and child health services are governed by factors such as income, level of education, and place of residence.
Highlights
Correspondence to: Background Globally, progress in Maternal and Child Health (MCH) has been inconsistent, with several evidence showing both between and within country disparities in several RMNCH outcome measures
These disparities are especially significant in Low and Middle-Income Countries (LMICs), with 99% of global maternal and neonatal death occurring in these countries [3]
We utilised a framework of eleven core RMNCH indicators from the 2010-2015 global strategy for women’s and children’s health [12], comprising of two mortality indicators, eight coverage indicators and one child nutrition indicators as follows: comprising of eight measures of intervention coverage, and three measures of impact as follows: U5MR, stunting in children under five, Maternal Mortality Rate, unmet need for contraception, Antenatal Care (ANC) coverage, Skilled Birth Attendant (SBA), ARV prophylaxis for HIV positive pregnant women, Postnatal Care (PNC) for mothers and babies within two days of birth, exclusive breastfeeding, three doses of combined diphtheria-tetanus-pertussis immunization coverage (DPT3), and care seeking for suspected pneumonia [13]
Summary
We aim to meta-analyse existing literature on association between three major equity stratifiers and a selection of RMNCH indicators. The objective of our study is to fill the gap concerning the lack of meta-analysis, and to provide a pooled evidence base on the association between a selection of RMNCH indicators, and three important equity stratifiers, with focus on studies that utilised nationally representative data
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