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Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis

BACKGROUND: Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programme...

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Autores principales: Dewau, Reta, Angaw, Dessie Abebaw, Kassa, Getahun Molla, Dagnew, Baye, Yeshaw, Yigizie, Muche, Amare, Feleke, Dejen Getaneh, Molla, Eshetie, Yehuala, Enyew Dagnew, Tadesse, Sisay Eshete, Yalew, Melaku, Fentaw, Zinabu, Asfaw, Ahmed Hussien, Andargie, Assefa, Chanie, Muluken Genetu, Ayele, Wolde Melese, Hassen, Anissa Mohammed, Damtie, Yitayish, Hussein, Foziya Mohammed, Asfaw, Zinet Abegaz, Addisu, Elsabeth, Adane, Bezawit, Ayele, Fanos Yeshanew, Kefale, Bereket, Zerga, Aregash Abebayehu, Mekonnen, Tefera Chane, Necho, Mogesie, Ebrahim, Oumer Abdulkadir, Adane, Metadel, Ayele, Tadesse Awoke
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323938/
https://www.ncbi.nlm.nih.gov/pubmed/34329310
http://dx.doi.org/10.1371/journal.pone.0255094
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author Dewau, Reta
Angaw, Dessie Abebaw
Kassa, Getahun Molla
Dagnew, Baye
Yeshaw, Yigizie
Muche, Amare
Feleke, Dejen Getaneh
Molla, Eshetie
Yehuala, Enyew Dagnew
Tadesse, Sisay Eshete
Yalew, Melaku
Fentaw, Zinabu
Asfaw, Ahmed Hussien
Andargie, Assefa
Chanie, Muluken Genetu
Ayele, Wolde Melese
Hassen, Anissa Mohammed
Damtie, Yitayish
Hussein, Foziya Mohammed
Asfaw, Zinet Abegaz
Addisu, Elsabeth
Adane, Bezawit
Ayele, Fanos Yeshanew
Kefale, Bereket
Zerga, Aregash Abebayehu
Mekonnen, Tefera Chane
Necho, Mogesie
Ebrahim, Oumer Abdulkadir
Adane, Metadel
Ayele, Tadesse Awoke
author_facet Dewau, Reta
Angaw, Dessie Abebaw
Kassa, Getahun Molla
Dagnew, Baye
Yeshaw, Yigizie
Muche, Amare
Feleke, Dejen Getaneh
Molla, Eshetie
Yehuala, Enyew Dagnew
Tadesse, Sisay Eshete
Yalew, Melaku
Fentaw, Zinabu
Asfaw, Ahmed Hussien
Andargie, Assefa
Chanie, Muluken Genetu
Ayele, Wolde Melese
Hassen, Anissa Mohammed
Damtie, Yitayish
Hussein, Foziya Mohammed
Asfaw, Zinet Abegaz
Addisu, Elsabeth
Adane, Bezawit
Ayele, Fanos Yeshanew
Kefale, Bereket
Zerga, Aregash Abebayehu
Mekonnen, Tefera Chane
Necho, Mogesie
Ebrahim, Oumer Abdulkadir
Adane, Metadel
Ayele, Tadesse Awoke
author_sort Dewau, Reta
collection PubMed
description BACKGROUND: Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. METHODS: The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). RESULTS: The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. CONCLUSIONS: The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women’s income, access to health care facilities to increase the frequency of antenatal care utilization.
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spelling pubmed-83239382021-07-31 Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis Dewau, Reta Angaw, Dessie Abebaw Kassa, Getahun Molla Dagnew, Baye Yeshaw, Yigizie Muche, Amare Feleke, Dejen Getaneh Molla, Eshetie Yehuala, Enyew Dagnew Tadesse, Sisay Eshete Yalew, Melaku Fentaw, Zinabu Asfaw, Ahmed Hussien Andargie, Assefa Chanie, Muluken Genetu Ayele, Wolde Melese Hassen, Anissa Mohammed Damtie, Yitayish Hussein, Foziya Mohammed Asfaw, Zinet Abegaz Addisu, Elsabeth Adane, Bezawit Ayele, Fanos Yeshanew Kefale, Bereket Zerga, Aregash Abebayehu Mekonnen, Tefera Chane Necho, Mogesie Ebrahim, Oumer Abdulkadir Adane, Metadel Ayele, Tadesse Awoke PLoS One Research Article BACKGROUND: Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. METHODS: The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). RESULTS: The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. CONCLUSIONS: The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women’s income, access to health care facilities to increase the frequency of antenatal care utilization. Public Library of Science 2021-07-30 /pmc/articles/PMC8323938/ /pubmed/34329310 http://dx.doi.org/10.1371/journal.pone.0255094 Text en © 2021 Dewau et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Dewau, Reta
Angaw, Dessie Abebaw
Kassa, Getahun Molla
Dagnew, Baye
Yeshaw, Yigizie
Muche, Amare
Feleke, Dejen Getaneh
Molla, Eshetie
Yehuala, Enyew Dagnew
Tadesse, Sisay Eshete
Yalew, Melaku
Fentaw, Zinabu
Asfaw, Ahmed Hussien
Andargie, Assefa
Chanie, Muluken Genetu
Ayele, Wolde Melese
Hassen, Anissa Mohammed
Damtie, Yitayish
Hussein, Foziya Mohammed
Asfaw, Zinet Abegaz
Addisu, Elsabeth
Adane, Bezawit
Ayele, Fanos Yeshanew
Kefale, Bereket
Zerga, Aregash Abebayehu
Mekonnen, Tefera Chane
Necho, Mogesie
Ebrahim, Oumer Abdulkadir
Adane, Metadel
Ayele, Tadesse Awoke
Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis
title Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis
title_full Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis
title_fullStr Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis
title_full_unstemmed Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis
title_short Urban-rural disparities in institutional delivery among women in East Africa: A decomposition analysis
title_sort urban-rural disparities in institutional delivery among women in east africa: a decomposition analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323938/
https://www.ncbi.nlm.nih.gov/pubmed/34329310
http://dx.doi.org/10.1371/journal.pone.0255094
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