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Inequities in neonatal survival interventions: evidence from national surveys
Bridget Fenn1, Betty R Kirkwood, Zahra Popatia
1Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. bridget.fenn@lshtm.ac.uk
Insights
Millions of children die neonatally each year. This study reveals significant wealth-based inequities in neonatal mortality and intervention coverage across eight countries, highlighting the need for equitable health strategies.
Area of Science:
- Global Health Equity
- Neonatal Mortality Research
- Public Health Interventions
Background:
- Each year, nearly four million infants die within the first four weeks of life.
- Addressing neonatal mortality is crucial for achieving global child survival goals.
Purpose of the Study:
- To quantify within-country disparities in neonatal mortality rates.
- To assess inequities in the coverage of essential neonatal interventions.
Main Methods:
- Utilized empirical data from Demographic and Health Surveys in eight countries.
- Calculated neonatal, infant, and under-two mortality rates using direct estimation.
- Analyzed wealth-based inequities using wealth quintiles and concentration indices.
Main Results:
- Significant neonatal mortality inequities were observed across wealth groups in most countries.
- Poorer populations experienced higher neonatal mortality and lower intervention coverage.
- Coverage of skilled birth attendance and antenatal care varied dramatically between wealth quintiles.
Conclusions:
- Reducing socioeconomic inequities is essential for decreasing neonatal and overall child mortality.
- Future intervention programs must integrate equity considerations into their design and implementation.
Background:
Nearly four million children die during the first four weeks of life every year, yet known and effective interventions exist. Neonatal mortality has to be addressed to reach the millennium development goal for child survival.
Aims:
To determine the extent of within-country inequities in neonatal mortality and effective intervention coverage.
Methods:
Neonatal, infant and child (under 2 years) mortality rates were calculated from empirical data from Demographic and Health Surveys for eight countries using direct estimation techniques. Wealth groups were constructed using the World Bank wealth index; neonatal mortality inequities were evaluated by comparing low:high quintile ratios; concentration indices were calculated for intervention coverage rates.
Results:
The proportion of under-2 deaths occurring in the neonatal period ranged from 24.3% (Malawi) to 49.4% (Bangladesh). In all countries (excluding Haiti) inequities in neonatal mortality and intervention coverage were evident across wealth groups with more deaths and less coverage in the poorest, compared with the richest, quintile; the largest mortality differential was 2.1 (Nicaragua) and the smallest was 1.2 (Eritrea). In Nicaragua 33% of the poorest women had a skilled delivery compared with 98% of the richest; in Cambodia for antenatal care this was 18% (poorest) and 71% (richest). Low coverage of interventions tended to show top inequity patterns whereas high coverage tended to show bottom inequity patterns.
Conclusions:
Reducing inequity is a necessary step in reducing neonatal deaths and also total child deaths. Intervention efforts need to begin to integrate approaches relevant to equity in programme design, implementation, monitoring and evaluation.
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