Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind

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dc.contributor.authorLukwa, Akim T
dc.contributor.authorSiya, Aggrey
dc.contributor.authorOdunitan-Wayas, Feyisayo A
dc.contributor.authorAlaba, Olufunke
dc.date.accessioned2022-04-13T09:57:07Z
dc.date.available2022-04-13T09:57:07Z
dc.date.issued2022-03-23
dc.date.updated2022-03-27T03:10:25Z
dc.description.abstractBackground 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.en_US
dc.identifier.apacitationLukwa, A. T., Siya, A., Odunitan-Wayas, F. A., & Alaba, O. (2022). Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind. <i>BMC Pregnancy and Childbirth</i>, 22(1), 239. http://hdl.handle.net/11427/36372en_ZA
dc.identifier.chicagocitationLukwa, Akim T, Aggrey Siya, Feyisayo A Odunitan-Wayas, and Olufunke Alaba "Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind." <i>BMC Pregnancy and Childbirth</i> 22, 1. (2022): 239. http://hdl.handle.net/11427/36372en_ZA
dc.identifier.citationLukwa, A.T., Siya, A., Odunitan-Wayas, F.A. & Alaba, O. 2022. Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind. <i>BMC Pregnancy and Childbirth.</i> 22(1):239. http://hdl.handle.net/11427/36372en_ZA
dc.identifier.ris TY - Journal Article AU - Lukwa, Akim T AU - Siya, Aggrey AU - Odunitan-Wayas, Feyisayo A AU - Alaba, Olufunke AB - 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. DA - 2022-03-23 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Pregnancy and Childbirth KW - Decomposition analysis KW - Erreygers normalized concentration index KW - Concentration index KW - Skilled birth attendance KW - Antenatal care KW - Postnatal care KW - Maternal health in Zimbabwe LK - https://open.uct.ac.za PY - 2022 T1 - Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind TI - Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind UR - http://hdl.handle.net/11427/36372 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12884-022-04571-9
dc.identifier.urihttp://hdl.handle.net/11427/36372
dc.identifier.vancouvercitationLukwa AT, Siya A, Odunitan-Wayas FA, Alaba O. Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind. BMC Pregnancy and Childbirth. 2022;22(1):239. http://hdl.handle.net/11427/36372.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDepartment of Public Health and Family Medicineen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Pregnancy and Childbirthen_US
dc.source.journalissue1en_US
dc.source.journalvolume22en_US
dc.source.pagination239en_US
dc.source.urihttps://bmcpregnancychildbirth.biomedcentral.com/
dc.source.urihttps://bmcpregnancychildbirth.biomedcentral.com/
dc.subjectDecomposition analysisen_US
dc.subjectErreygers normalized concentration indexen_US
dc.subjectConcentration indexen_US
dc.subjectSkilled birth attendanceen_US
dc.subjectAntenatal careen_US
dc.subjectPostnatal careen_US
dc.subjectMaternal health in Zimbabween_US
dc.titleDecomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behinden_US
dc.typeJournal Articleen_US
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