Systematic review and meta-analysis of the association between dimensions of inequality and a selection of indicators of Reproductive, Maternal, Newborn and Child Health (RMNCH)

Adeyinka E Adegbosin, Hong Zhou, Sen Wang, Bela Stantic, Jing Sun
2019 Journal of Global Health  
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. In this study, we aim to meta-analyse existing literature on association between three major equity stratifiers and a selection of RMNCH indicators. Methods We searched PubMed, Embase, Scopus databases and grey literatures from the WHO, UNICEF and World Bank publications. Using the PRIS-MA guidelines, we
more » ... delines, 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. Results A 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; I 2 = 98%, P = 0.006) and (OR = 6.17 (95% CI = 3.03-12.56; I 2 = 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; I 2 = 96%, P = 0.77). Conclusions In 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. Electronic supplementary material: The online version of this article contains supplementary material. journal of health global Progress in both intervention and impact indicators of maternal and child health have been inconsistent over several decades, with several evidences showing both between and within country disparities in several of these RMNCH indicators [1, 2] . 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] . Furthermore, disparities in access to RMNCH interventions that require fixed health facilities such as antenatal care, skilled birth and postnatal care services
doi:10.7189/jogh.09.010429 fatcat:mju746hn4nbahkonmwz5foudhy