Unequal treatment: challenging socioeconomic and living area disparities in oral rehydration therapy and continued feeding in 35 Sub-Saharan African countries
Background While the 2030 global goal has motivated proliferation of equity-oriented studies globally, we did not find sweeping studies on disparity in Oral Rehydration Theory (ORT) and continued feeding at the level of the Sub-Saharan Africa (SSA) region. Yet, exploring the within and between-country variations of the service could help synthesize useful policy lessons that can be applied to other settings within the region. We aimed to generate evidence on inequality in use of the service at
... of the service at the level of SSA in order to suggest the way forward to advance the momentum already gained in the region with respect to improving coverage of this lifesaving interventions. Method We applied the World Health Organization's Health Equity Assessment Toolkit for the analysis. Data were obtained from Demographic and Health Surveys conducted between 2012 and 2016. Thirty-five countries were selected from different income categories in SSA. ORT and continued feeding disparity was analyzed with respect to five dimensions of inequality (wealth, education, sex, residence and subnational regions) through four measures of inequality: difference, ratio, population attributable risk and fraction. Results Disparity in use of ORT and continued feeding plagued SSA and consistently favored advantaged population subgroups. In 20 out of 35 countries, the service was disproportionately concentrated among children from well to do households. The inequality was strikingly pronounced in Angola, Guinea, Cameroon and Mali. We also recorded sizable variations with respect to residence and education in 23 and 11 countries. Interestingly, male and female children get the service almost equally in most countries, with only four countries (Niger, Kenya, Guinea-Bissau, and Senegal) suffered sex differentials, generally to the favor of male children. Conclusion In SSA, unjustified disparity around use of ORT and continued feeding is a pervasive problem that requires resolute policy response soon. Eliminating the disparity would set the region miles ahead to reaching the child health related global goals to be attained in 2030. The region might benefit from equitable economic and education policies.