Equity in antenatal care quality

An analysis of 91 national household surveys

Datos Bibliográficos

ID23378154
AutoresCatherine Arsenault (0000-0003-2410-3015, Harvard University, autor de correspondencia), Kathleen Jordan (0000-0002-9332-9491, New York University), Keely Jordan, Dennis Lee (0000-0001-6900-5158, Harvard Global Health Institute), Girmaye Dinsa (Haramaya University), Fatuma Manzi (0000-0001-9110-0776, Ifakara Health Institute), Tanya Marchant (0000-0002-4228-4334, London School of Hygiene & Tropical Medicine), Margaret E Kruk (0000-0002-9549-8432, Harvard Global Health Institute)
Año2018
Volumen6
Número11
Páginase1186-e1195
Fecha de publicación2018-11-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaThe Lancet Global Health (JOURNAL)
Identificadores de la revistaISSN: 2214-109X • E-ISSN: 2572-116X
EditorialElsevier BV (PUBLISHER)
DOI10.1016/s2214-109x(18)30389-9
PMID30322649
OpenAlexW2896900165
IdiomaEN
Citas recibidas59
Referencias citadas34

BACKGROUND: Emerging data show that many low-income and middle-income country (LMIC) health systems struggle to consistently provide good-quality care. Although monitoring of inequalities in access to health services has been the focus of major international efforts, inequalities in health-care quality have not been systematically examined. METHODS: Using the most recent (2007-16) Demographic and Health Surveys and Multiple Indicator Cluster Surveys in 91 LMICs, we described antenatal care quality based on receipt of three essential services (blood pressure monitoring and urine and blood testing) among women who had at least one visit with a skilled antenatal-care provider. We compared quality across country income groups and quantified within-country wealth-related inequalities using the slope and relative indices of inequality. We summarised inequalities using random-effects meta-analyses and assessed the extent to which other geographical and sociodemographic factors could explain these inequalities. FINDINGS: Globally, 72·9% (95% CI 69·1-76·8) of women who used antenatal care reported blood pressure monitoring and urine and blood testing; this number ranged from 6·3% in Burundi to 100·0% in Belarus. Antenatal care quality lagged behind antenatal care coverage the most in low-income countries, where 86·6% (83·4-89·7) of women accessed care but only 53·8% (44·3-63·3) reported receiving the three services. Receipt of the three services was correlated with gross domestic product per capita and was 40 percentage points higher in upper-middle-income countries compared with low-income countries. Within countries, the wealthiest women were on average four times more likely to report good quality care than the poorest (relative index of inequality 4·01, 95% CI 3·90-4·13). Substantial inequality remained after adjustment for subnational region, urban residence, maternal age, education, and number of antenatal care visits (3·20, 3·11-3·30). INTERPRETATION: Many LMICs that have reached high levels of antenatal care coverage had much lower and inequitable levels of quality. Achieving ambitious maternal, newborn, and child health goals will require greater focus on the quality of health services and their equitable distribution. Equity in effective coverage should be used as the new metric to monitor progress towards universal health coverage. FUNDING: Bill & Melinda Gates Foundation.

Business · Developing country · Economic growth · Economics · Environmental health · Equity (law) · Gross domestic product · Health care · Inequality · Per capita · Political science · Population · Receipt · Demography · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Primary Care and Health Outcomes