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Wealth inequalities in reproductive and child health preventive care in Mozambique: a decomposition analysis.

Authors
  • Daca, Chanvo S L1, 2
  • Schumann, Barbara2
  • Arnaldo, Carlos3
  • San Sebastian, Miguel2
  • 1 Department of Cooperation, Ministry of Health, Directorate of Planning and Cooperation, Maputo, Mozambique. , (Mozambique)
  • 2 Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden. , (Sweden)
  • 3 Universidade Eduardo Mondlane, Maputo, Mozambique. , (Mozambique)
Type
Published Article
Journal
Global Health Action
Publisher
Informa UK (Taylor & Francis)
Publication Date
Dec 31, 2022
Volume
15
Issue
1
Pages
2040150–2040150
Identifiers
DOI: 10.1080/16549716.2022.2040150
PMID: 35290171
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Assessing the gap between rich and poor is important to monitor inequalities in health. Identifying the contribution to that gap can help policymakers to develop interventions towards decreasing that difference. To quantify the wealth inequalities in health preventive measures (bed net use, vaccination, and contraceptive use) to determine the demographic and socioeconomic contribution factors to that inequality using a decomposition analysis. Data from the 2015 Immunisation, Malaria and AIDs Indicators Survey were used. The total sample included 6946 women aged 15-49 years. Outcomes were use of insecticide-treated nets (ITN), child vaccination, and modern contraception use. Wealth Index was the exposure variable and age, marital status, place of residence, region, education, occupation, and household wealth index were the explanatory variables. Wealth inequalities were assessed using concentration indexes (Cindex). Wagstaff-decomposition analysis was conducted to assess the determinants of the wealth inequality. The Cindex was -0.081 for non-ITN, -0.189 for lack of vaccination coverage and -0.284 for non-contraceptive use, indicating a pro-poor inequality. The results revealed that 88.41% of wealth gap for ITN was explained by socioeconomic factors, with education and wealth playing the largest roles. Lack of full vaccination, socioeconomic factors made the largest contribution, through the wealth variable, whereas geographic factors came next. Finally, the lack of contraceptive use, socioeconomic factors were the main explanatory factors, but to a lesser degree than the other two outcomes, with wealth and education contributing most to explaining the gap. There was a pro-poor inequality in reproductive and child preventive measures in Mozambique. The greater part of this inequality could be attributed to wealth, education, and residence in rural areas. Resources should be channeled into poor and non-educated rural communities to tackle these persistent inequities in preventive care.

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