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Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa

BACKGROUND: Improved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saha...

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Autores principales: Bobo, Firew Tekle, Asante, Augustine, Woldie, Mirkuzie, Dawson, Angela, Hayen, Andrew
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559094/
https://www.ncbi.nlm.nih.gov/pubmed/34716145
http://dx.doi.org/10.1136/bmjgh-2021-007074
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author Bobo, Firew Tekle
Asante, Augustine
Woldie, Mirkuzie
Dawson, Angela
Hayen, Andrew
author_facet Bobo, Firew Tekle
Asante, Augustine
Woldie, Mirkuzie
Dawson, Angela
Hayen, Andrew
author_sort Bobo, Firew Tekle
collection PubMed
description BACKGROUND: Improved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa. METHODS: We analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section. RESULTS: The rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant at birth was extremely high, with a difference of 46.2 percentage points between the poorest quintile (44.4%) and the richest quintile (90.6%). In 10 out of 25 countries, the caesarean section rate was less than 1% among the poorest quintile, but the rate was more than 15% among the richest quintile in nine countries. Four or more antenatal care contacts, improved maternal education, higher household wealth status and frequently listening to the radio increased the rates of having skilled attendant at birth and caesarean section. Women who reside in rural areas and those who have to travel long distances to access health facilities were less likely to have skilled attendant at birth or caesarean section. CONCLUSIONS: There were significant within-country wealth-related inequalities in having skilled attendant at birth and caesarean delivery. Efforts to improve access to birth at the facility should begin in areas with low coverage and directly consider the needs and experiences of vulnerable populations.
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spelling pubmed-85590942021-11-04 Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa Bobo, Firew Tekle Asante, Augustine Woldie, Mirkuzie Dawson, Angela Hayen, Andrew BMJ Glob Health Original Research BACKGROUND: Improved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa. METHODS: We analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section. RESULTS: The rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant at birth was extremely high, with a difference of 46.2 percentage points between the poorest quintile (44.4%) and the richest quintile (90.6%). In 10 out of 25 countries, the caesarean section rate was less than 1% among the poorest quintile, but the rate was more than 15% among the richest quintile in nine countries. Four or more antenatal care contacts, improved maternal education, higher household wealth status and frequently listening to the radio increased the rates of having skilled attendant at birth and caesarean section. Women who reside in rural areas and those who have to travel long distances to access health facilities were less likely to have skilled attendant at birth or caesarean section. CONCLUSIONS: There were significant within-country wealth-related inequalities in having skilled attendant at birth and caesarean delivery. Efforts to improve access to birth at the facility should begin in areas with low coverage and directly consider the needs and experiences of vulnerable populations. BMJ Publishing Group 2021-10-29 /pmc/articles/PMC8559094/ /pubmed/34716145 http://dx.doi.org/10.1136/bmjgh-2021-007074 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Bobo, Firew Tekle
Asante, Augustine
Woldie, Mirkuzie
Dawson, Angela
Hayen, Andrew
Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa
title Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa
title_full Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa
title_fullStr Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa
title_full_unstemmed Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa
title_short Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa
title_sort spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-saharan africa
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8559094/
https://www.ncbi.nlm.nih.gov/pubmed/34716145
http://dx.doi.org/10.1136/bmjgh-2021-007074
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