Browsing by Subject "Concentration index"

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    Open Access
    Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind
    (2022-03-23) Lukwa, Akim T; Siya, Aggrey; Odunitan-Wayas, Feyisayo A; Alaba, Olufunke
    Background Several studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being. Methods This study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe. Results Overall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55–3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08–0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03–1.90)] and richest households [OR: 2.36 (CI: 1.39–3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (− 0.10)]. Conclusion Decomposition analysis showed household wealth, husband’s education, women’s education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality.
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    Open Access
    Lifestyle and Income-related Inequality in Health in South Africa
    (2017) Mukong, Alfred Kechia; van Walbeek, Corné; Ross, Hana
    BACKGROUND: Many low- and middle-income countries are experiencing an epidemiological transition from communicable to non-communicable diseases. This has negative consequences for their human capital development, and imposes a growing economic burden on their societies. While the prevalence of such diseases varies with socioeconomic status, the inequalities can be exacerbated by adopted lifestyles of individuals. Evidence suggests that lifestyle factors may explain the income-related inequality in self-reported health. Self-reported health is a subjective evaluation of people's general health status rather than an objective measure of lifestyle-related ill-health. METHOD: The objective of this paper is to expand the literature by examining the contribution of smoking and alcohol consumption to health inequalities, incorporating more objective measures of health, that are directly associated with these lifestyle practices. We used the National Income Dynamic Study panel data for South Africa. The corrected concentration index is used to measure inequalities in health outcomes. We use a decomposition technique to identify the contribution of smoking and alcohol use to inequalities in health. RESULTS: We find significant smoking-related and income-related inequalities in both self-reported and lifestyle-related ill-health. The results suggest that smoking and alcohol use contribute positively to income-related inequality in health. Smoking participation accounts for up to 7.35% of all measured inequality in health and 3.11% of the inequality in self-reported health. The estimates are generally higher for all measured inequality in health (up to 14.67%) when smoking duration is considered. Alcohol consumption accounts for 27.83% of all measured inequality in health and 3.63% of the inequality in self-reported health. CONCLUSION: This study provides evidence that inequalities in both self-reported and lifestyle-related ill-health are highly prevalent within smokers and the poor. These inequalities need to be explicitly addressed in future programme planning to reduce health inequalities in South Africa. We suggest that policies that can influence poor individuals to reduce tobacco consumption and harmful alcohol use will improve their health and reduce health inequalities.