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Tamir TT, Mohammed Y, Kassie AT, Zegeye AF. Early neonatal mortality and determinants in sub-Saharan Africa: Findings from recent demographic and health survey data. PLoS One 2024; 19:e0304065. [PMID: 38848390 PMCID: PMC11161111 DOI: 10.1371/journal.pone.0304065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
INTRODUCTION Neonatal mortality during the first week of life is a global issue that is responsible for a large portion of deaths among children under the age of five. There are, however, very few reports about the issue in sub-Saharan Africa. For the sake of developing appropriate policies and initiatives that could aid in addressing the issue, it is important to study the prevalence of mortality during the early neonatal period and associated factors. Thus, the aim of this study was to ascertain the prevalence of and pinpoint the contributing factors to early neonatal mortality in sub-Saharan Africa. METHOD Data from recent demographic and health surveys in sub-Saharan African countries was used for this study. The study included 262,763 live births in total. The determinants of early newborn mortality were identified using a multilevel mixed-effects logistic regression model. To determine the strength and significance of the association between outcome and explanatory variables, the adjusted odds ratio (AOR) at a 95% confidence interval (CI) was computed. Independent variables were deemed statistically significant when the p-value was less than the significance level (0.05). RESULT Early neonatal mortality in sub-Saharan Africa was 22.94 deaths per 1,000 live births. It was found to be significantly associated with maternal age over 35 years (AOR = 1.77, 95% CI: 1.34-2.33), low birth weight (AOR = 3.27, 95% CI: 2.16, 4.94), less than four ANC visits (AOR = 1.12, 95% CI: 1.01, 1.33), delivery with caesarean section (AOR = 1.81, 95% CI: 1.30-2.5), not having any complications during pregnancy (AOR = 0.76, 95% CI: 0.61, 94), and community poverty (AOR = 1.32, 95% CI: 1.05-1.65). CONCLUSION This study found that about twenty-three neonates out of one thousand live births died within the first week of life in sub-Saharan Africa. The age of mothers, birth weight, antenatal care service utilization, mode of delivery, multiple pregnancy, complications during pregnancy, and community poverty should be considered while designing policies and strategies targeting early neonatal mortality in sub-Saharan Africa.
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Affiliation(s)
- Tadesse Tarik Tamir
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yirgalem Mohammed
- Department of Health system and Policy, College of Medicine and Health Science, School of Public Health, Wollo University, Dessie, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Khosravi A, Mohamadi E, Sheidaei A, Shafiee G, Heshmat R, Olyaeemanesh A, Takian A. Child mortality inequalities and socioeconomic determinants of health in Iran, 2016-2018. J Public Health Policy 2023; 44:535-550. [PMID: 37898702 DOI: 10.1057/s41271-023-00448-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 10/30/2023]
Abstract
Measuring health inequalities is essential to inform policy making and for monitoring implementation to reduce avoidable and unfair differences in health status. We conducted a geospatial analysis of child mortality in Iran using death records from the Ministry of Health and Medical Education from 2016 to 2018 stratified by sex, age, province, and district, and household expenditure and income survey data from the Statistical Center of Iran collected in 2017. We applied multilevel mixed-effect models and detected significant inequality in child mortality and the impact of socioeconomic factors, especially household income. We advocate for using mortality rate for young children (< 5 years old) as an indicator for assessing the impact of interventions to reduce inequalities among various socioeconomic groups. We also recommend to design and implement comprehensive and longitudinal data collection systems for accurate, regular, and specific monitoring of health inequalities.
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Affiliation(s)
- Ardeshir Khosravi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- Iranian Ministry of Health and Medical Education, Tehran, Iran
| | - Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Gita Shafiee
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Ramin Heshmat
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
| | - Alireza Olyaeemanesh
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran
- National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Amirhossein Takian
- Health Equity Research Center (HERC), Tehran University of Medical Sciences (TUMS), Tehran, Iran.
- Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences (TUMS), Poursina Avenue, Qods Street, Enqelab Square, Tehran, Iran.
- Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
- National Center for Health Insurance Research, Tehran, Iran.
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Haghighatfard P, Rezapour A, Khoramrooz M, Eisavi M, Khosravi A. Factors Explaining the Change in Socioeconomic Inequality of Disability in Iran: A Repeated Cross-sectional Study. Med J Islam Repub Iran 2023; 37:90. [PMID: 37750096 PMCID: PMC10518069 DOI: 10.47176/mjiri.37.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Indexed: 09/27/2023] Open
Abstract
Background More than 15% of the world's population live with some form of disability. Assessing socioeconomic inequalities in disability and monitoring its change over time can help policymakers to design and implement targeted interventions to reduce these inequalities. This study aimed to assess the change in socioeconomic inequality in disability in Iran from 2000 to 2010. Methods Data for this cross-sectional study were obtained from 2 waves of Iran's demographic and health surveys (2000 and 2010). The Wagstaff normalized concentration index was used to measure the socioeconomic inequality of disability. Contributing factors to the inequality in 2000 and 2010 were investigated by concentration index decomposition. The Blinder-Oaxaca decomposition method was used to determine contributing factors of change in disability inequality. All analyses were conducted in Stata14. Results The negative and statistically significant concentration indices (-0.132 in 2000 and -0.165 in 2010, P < 0.001) suggested more concentration of disability among poor people. The absolute value of inequality was increased by 0.034 between the 2 points of time (P = 0.025). Level of education (123.5%), household size (12.9%), age (-35.1%), and residency (in terms of Iran's provinces) (-19.3%) were the contributing factors to the measured disability inequality in 2000. In 2010, level of education (105.8%), household size (30.5%), and urban residency (-46.3%) explained the measured inequality. Change in disability inequality was explained by household size (99.4%), province of residence (54.8%), education (36.9%), socioeconomic status (20%), urban residency (-90.3%), and age (-47.7%). Conclusion Iran suffers from significant socioeconomic inequality in disability, and it significantly increased over time. Interventions such as increasing health literacy and providing suitable job opportunities for people with low education level, improving the socioeconomic status of extended households, and paying more attention to the balanced development in the provinces and urban and rural areas, and attending to prevention, treatment, and mitigation of disability adversities among poor young and elderly people could be recommended to tackle increased socioeconomic inequality in disability and its unfavorable consequences in Iran.
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Affiliation(s)
- Payam Haghighatfard
- Department of Health Economics, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Iran University of
Medical Sciences, Tehran, Iran
| | - Maryam Khoramrooz
- Department of Health Management and Economics, School of Public Health,
Hamadan University of Medical Sciences, Hamadan, Iran
- Modeling of Noncommunicable Diseases Research Center, Hamadan
University of Medical Sciences, Hamadan, Iran
| | - Mahmoud Eisavi
- Faculty of Economics, Allameh Tabataba'i University, Tehran, Iran
| | - Ardeshir Khosravi
- Deputy for Public Health, Iranian Ministry of Health and Medical
Education, Tehran, Iran
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G C S, Adhikari N. Decomposing inequality in Maternal and Child Health (MCH) services in Nepal. BMC Public Health 2023; 23:995. [PMID: 37248553 DOI: 10.1186/s12889-023-15906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND About 75.5% of women in Nepal's urban areas receive at least four ANC visits, compared to 61.7% of women in the country's rural areas. Similarly, just 34% of women in the lowest wealth quintile give birth in a medical facility compared to 90% of women in the richest group. As a result of this inequality, the poor in emerging nations suffer since those who are better off can make greater use of the healthcare than those who are less fortunate. This study aims to examine and decompose the contributions of various socioeconomic factors towards MCH service inequality in Nepal in the years 2011 and 2016. METHODS Inequality in MCH services was estimated using concentration curves and their corresponding indices using data from Nepal Demographic Health Survey (NDHS) 2011 and 2016. We examined the inequality across three MCH service outcomes: less than 4 ANC visits, no postnatal checkups within 2 months of delivery and no SBA delivery and decomposed them across observed characteristics of the mothers aged between 15 and 49. Furthermore, Oaxaca-blinder decomposition approach was used to measure and decompose the inequality differential between two time periods. RESULTS Inequality in MCH services was prevalent for all 3 MCH outcomes in 2011 and 2016, respectively. However, the concentration indices for <4 ANC visits, no SBA delivery, and no postnatal checkups within 2 months of birth increased from -0.2184, -0.1643, and -0.1284 to -0.1871, -0.0504, and -0.0218 correspondingly, showing the decrease in MCH services inequality over two time periods. Wealth index, women's literacy, place of living, mother's employment status, and problem of distance to reach nearest health facility were the main contributors. CONCLUSION We find that MCH services are clearly biased towards the women with higher living standards. National policies should focus on empowering women through education and employment, along with the creation of health facilities and improved educational institutions, in order to address inequalities in living standards, women's education levels, and the problem of distance. Leveraging these factors can reduce inequality in MCH services.
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Affiliation(s)
- Shreezal G C
- Central Department of Economics, Tribhuvan University, Kirtipur, 44600, Kathmandu, Nepal.
| | - Naveen Adhikari
- Central Department of Economics, Tribhuvan University, Kirtipur, 44600, Kathmandu, Nepal
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Tamir TT, Asmamaw DB, Negash WD, Belachew TB, Fentie EA, Kidie AA, Amare T, Fetene SM, Addis B, Wubante SM, Endawkie A, Zegeye AF. Prevalence and determinants of early neonatal mortality in Ethiopia: findings from the Ethiopian Demographic and Health Survey 2016. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2023-001897. [PMID: 37208032 DOI: 10.1136/bmjpo-2023-001897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/01/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Early neonatal death accounts for a significant number of under-5 mortality worldwide. However, the problem is under-researched and under-reported in low-income and middle-income countries, particularly in Ethiopia. The magnitude of mortality during the early neonatal period and associated factors should be studied for designing appropriate policies, and strategies that could help tackle the problem. Hence, this study aimed to determine the prevalence and identify factors associated with early neonatal mortality in Ethiopia. METHODS This study was conducted by using data from Ethiopian Demographic and Health Survey 2016. A total of 10 525 live births were enrolled in the study. A multilevel logistic regression model was used to identify determinants of early neonatal mortality. Adjusted OR (AOR) at a 95% CI was computed to assess the strength and significance of the association between outcome and explanatory variables. Factors with a p<0.05 were declared statistically significant. RESULTS The national prevalence of early neonatal mortality in Ethiopia was 41.8 (95% CI 38.1 to 45.8) early neonatal deaths per 1000 live births. The extreme ages of pregnancy (under 20 years (AOR 2.7, 95% CI 1.3 to 5.5) and above 35 years (AOR 2.4, 95% CI 1.5 to 4)), home delivery (AOR 2.4, 95% CI 1.3 to 4.3), low birth weight (AOR 3.3, 95% CI 1.4 to 8.2) and multiple pregnancies (AOR 5.3, 95% CI 4.1 to 9.9) were significantly associated early neonatal mortality. CONCLUSIONS This study revealed a higher prevalence of early neonatal mortality as compared with prevalence in other low-income and middle-income countries. Thus, it is determined to be essential to design maternal and child health policies and initiatives with a priority on the prevention of early neonatal deaths. Emphasis should be given to babies born to mothers at extreme ages of pregnancy, to those born of multiple pregnancies delivered at home and to low birthweight babies.
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Affiliation(s)
| | | | | | | | - Elsa Awoke Fentie
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | | | - Tsegaw Amare
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | | | - Banchlay Addis
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Sisay Maru Wubante
- University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Kurjak A, Medjedovic E, Stanojević M. Use and misuse of ultrasound in obstetrics with reference to developing countries. J Perinat Med 2023; 51:240-252. [PMID: 36302110 DOI: 10.1515/jpm-2022-0438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022]
Abstract
Maternal and neonatal health is one of the main global health challenges. Every day, approximately 800 women and 7,000 newborns die due to complications during pregnancy, delivery, and neonatal period. The leading causes of maternal death in sub-Saharan Africa are obstetric hemorrhage (28.8%), hypertensive disorders in pregnancy (22.1%), non-obstetric complications (18.8%), and pregnancy-related infections (11.5%). Diagnostic ultrasound examinations can be used in a variety of specific circumstances during pregnancy. Because adverse outcomes may also arise in low-risk pregnancies, it is assumed that routine ultrasound in all pregnancies will enable earlier detection and improved management of pregnancy complications. The World Health Organization (WHO) estimated in 1997 that 50% of developing countries had no access to ultrasound imaging, and available equipment was outdated or broken. Unfortunately, besides all the exceptional benefits of ultrasound in obstetrics, its inappropriate use and abuse are reported. Using ultrasound to view, take a picture, or determine the sex of a fetus without a medical indication can be considered ethically unjustifiable. Ultrasound assessment when indicated should be every woman's right in the new era. However, it is still only a privilege in some parts of the world. Investment in both equipment and human resources has been clearly shown to be cost-effective and should be an obligatory step in the improvement of health care. Well-developed health systems should guide developing countries, creating principles for the organization of the health system with an accent on the correct, legal, and ethical use of diagnostic ultrasound in pregnancy to avoid its misuse. The aim of the article is to present the importance of correct and appropriate use of ultrasound in obstetrics and gynecology with reference to developing countries.
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Affiliation(s)
- Asim Kurjak
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Edin Medjedovic
- Clinic of Gynecology and Obstetrics, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Department of Gynecology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Milan Stanojević
- Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Zagreb, Croatia.,Neonatal Unit, Department of Obstetrics and Gynecology, Medical School University of Zagreb, Zagreb, Croatia
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Islam MA, Butt ZA, Sathi NJ. Prevalence of Neonatal Mortality and its Associated Factors: A Meta-analysis of Demographic and Health Survey Data from 21 Developing Countries. DR. SULAIMAN AL HABIB MEDICAL JOURNAL 2022. [DOI: 10.1007/s44229-022-00013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AbstractNeonatal mortality is high in developing countries, and reducing neonatal mortality is an indispensable part of the third Sustainable Development Goal. This study estimated the prevalence of neonatal mortality and the impact of maternal education, economic status, and utilization of antenatal care (ANC) services on neonatal mortality in developing countries. We used a cross-sectional study design to integrate data from 21 developing countries to acquire a wider perspective on neonatal mortality. A meta-analysis was conducted using the latest Demographic and Health Survey data from 21 developing countries. In addition, sensitivity analysis was adopted to assess the stability of the meta-analysis. The random-effects model indicated that women with higher education were less likely to experience neonatal death than mothers with up to primary education (odds ratio [OR] 0.820, 95% confidence interval [CI] 0.740–0.910). Women with higher socioeconomic status were less likely to experience neonatal death than mothers with lower socioeconomic status (OR 0.823, 95% CI 0.747–0.908). Mothers with ANC were less likely to experience neonatal death than those with no ANC (OR 0.374, 95% CI 0.323–0.433). Subgroup analysis showed that maternal education and ANC were more effective in Asian countries. In this study, mothers’ lower educational level, poor economic status, and lack of ANC were statistically significant factors associated with neonatal death in developing countries. The effect of these factors on neonatal death differed in different regions.
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Amini-Rarani M, Vahedi S, Borjali M, Nosratabadi M. Socioeconomic inequality in congenital heart diseases in Iran. Int J Equity Health 2021; 20:251. [PMID: 34863190 PMCID: PMC8645115 DOI: 10.1186/s12939-021-01591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/15/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Social-economic factors have an important role in shaping inequality in congenital heart diseases. The current study aimed to assess and decompose the socio-economic inequality in Congenital Heart Diseases (CHDs) in Iran. METHODS This is a cross-sectional research conducted at Shahid Rajaie Cardiovascular Medical and Research Center in Tehran, Iran, as one of the largest referral heart hospitals in Asia. Data were collected primarily from 600 mothers who attended in pediatric cardiology department in 2020. The polychoric principal component analysis (PCA) and Errygers corrected CI (ECI) were used to construct household socioeconomic status and to assess inequality in CHDs, respectively. A regression-based decomposition analysis was also applied to explain socioeconomic-related inequalities. To select the explanatory social, medical/biological, and lifestyle variables, the chi-square test was first used. RESULTS There was a significant pro-rich inequality in CHDs (ECI = -0.65, 95% CI, - 0.72 to - 0.58). The social, medical/biological, and lifestyle variables accounted for 51.47, 43.25, and 3.92% of inequality in CHDs, respectively. Among the social variables, family SES (about 50%) and mother's occupation (21.05%) contributed the most to CHDs' inequality. Besides, in the medical/biological group, receiving pregnancy care (22.06%) and using acid folic (15.70%) had the highest contribution. CONCLUSION We concluded that Iran suffers from substantial socioeconomic inequality in CHDs that can be predominantly explained by social and medical/biological variables. It seems that distributional policies aim to reduce income inequality while increasing access of prenatal care and folic acid for disadvantaged mothers could address this inequality much more strongly in Iran.
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Affiliation(s)
- Mostafa Amini-Rarani
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajad Vahedi
- Department of Health Care Management, School of Public Health, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran
| | - Maryam Borjali
- Department of Health and Social Welfare, School of Management and Medical Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Nosratabadi
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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Wasswa R, Kabagenyi A, Kananura RM, Jehopio J, Rutaremwa G. Determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006-2016: analysis of the Uganda Demographic and Health Surveys. BMJ Open 2021; 11:e053264. [PMID: 34753766 PMCID: PMC8578988 DOI: 10.1136/bmjopen-2021-053264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Teenage pregnancy has become a public health concern in Uganda because of its negative consequences to both the mother and child. The objective of this study was to examine the determinants of change in the inequality and associated predictors of teenage pregnancy in Uganda for the period 2006-2016. STUDY DESIGN A retrospective national cross-sectional study. SETTING: Uganda. PARTICIPANTS Uganda Demographic and Health Survey secondary data of only female teenagers aged 15-19 years. The samples selected for analyses were 1936 in 2006; 2048 in 2011 and 4264 in 2016. OUTCOME MEASURE The primary outcome was teenage pregnancy. Analysis was performed using the logistic regression, equiplots, concentration curve, normalised concentration index, decomposition of the concentration index and Oaxaca-type decomposition. RESULTS The prevalence of teenage pregnancy has seemingly remained high and almost constant from 2006 to 2016 with the risk worsening to the disadvantage of the poor. Household wealth-index, teenagers' years of education, early sexual debut and child marriage were the main key predictors and contributors of the large inequality in teenage pregnancy from 2006 to 2016. CONCLUSION Teenage pregnancy is disproportionately prevalent among different subpopulations of adolescent girls in Uganda. We therefore recommend policy actions to sensitise communities and enforcement of child rights and child protection laws to stop child marriages. There is also need to promote girl child education, improving household incomes, and intensifying mass media awareness on the risks of early pregnancies. Further, ensuring that villages have operational adolescent and youth friendly services as well as incorporating sex education and other different adolescent reproductive health programmes in school curriculum will be key measures in reducing the large inequality in teenage pregnancy.
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Affiliation(s)
- Ronald Wasswa
- Department of Statistical Methods and Actuarial Science, Makerere University College of Business and Management Sciences, Kampala, Uganda
| | - Allen Kabagenyi
- Department of Population Studies, Makerere University College of Business and Management Sciences, Kampala, Uganda
| | - Rornald Muhumuza Kananura
- International Development, London School of Economics and Political Science, London, UK
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Jehopio
- Department of Statistical Methods and Actuarial Science, Makerere University College of Business and Management Sciences, Kampala, Uganda
| | - Gideon Rutaremwa
- United Nations Economic Commission for Africa, Addis Ababa, Ethiopia
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Islam MA, Biswas B. Socio-economic factors associated with increased neonatal mortality: A mixed-method study of Bangladesh and 20 other developing countries based on demographic and health survey data. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Ghiasvand H, Mohamadi E, Olyaeemanesh A, Kiani MM, Armoon B, Takian A. Health equity in Iran: A systematic review. Med J Islam Repub Iran 2021; 35:51. [PMID: 34268239 PMCID: PMC8271272 DOI: 10.47176/mjiri.35.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Health inequities are among debatable and challenging aspects of health systems. Achieving equity through social determinants of health approach has been mentioned in most upstream national plans and acts in Iran. This paper reports the findings of a systematic review of the current synthesized evidence on health equity in Iran.
Methods: This is a narrative systematic review. The relevant concepts and terminology in health equity was found through MeSH. We retrieved the relevant studies from PubMed/MedLine, Social Sciences Database, and Google Scholar in English, plus the Jihad University Database (SID), and Google Scholar in Farsi databases from 1979 until the end of January 2018. The retrieved evidence has been assessed primarily based on PICOS criteria and then Ottawa-Newcastle Scale, and CASP for qualitative studies. We used PRISMA flow diagram and a narrative approach for synthesizing the evidence.
Results: We retrieved 172 455 studies. Following the primary and quality appraisal process, 114 studies were entered in the final phase of the analysis. The main part (approximately 95%) of the final phase included cross-sectional studies that had been analyzed through current descriptive inequality analysis indicators, analytical regression, or decomposition-based approaches. The studies were categorized within 3 main groups: health outcomes (40.3%), health utilization (32%), and health expenditures (27%).
Conclusion: As a part of understanding the current situation of health equity in the policymakers’ need to refer the retrieved evidence in this study, they need more inputs specially regarding the social determinants of health approach. It seems that health equity research plan in Iran needs to be redirected in new paths that give appropriate weights to biological, gene-based, environmental and contextbased, economic, social, and political aspects of health as well. We advocate addressing the aspects of Social Determinant of Health (SDH) in analyzing health inequalities.
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Affiliation(s)
- Hesam Ghiasvand
- Health Economics Group, Medical School, Institute of Health Researches, South Cloister Building, University of Exeter, United Kingdom
| | - Efat Mohamadi
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- National Institute of Health Research, Tehran University of Medical Sciences (TUMS), Tehran, Iran.,Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Kiani
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Amirhossein Takian
- Health Equity Research Center (HERC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Management and Health Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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12
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Islam MA, Tabassum T. Does antenatal and post-natal program reduce infant mortality? A meta-analytical review on 24 developing countries based on Demographic and Health Survey data. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 28:100616. [PMID: 33799165 DOI: 10.1016/j.srhc.2021.100616] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 03/08/2021] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study intended to reveal the effectiveness of Antenatal Care (ANC) and Postnatal care (PNC) services on infant mortality in 24 developing countries by utilizing the recent Demographic and Health Survey (DHS) data. DESIGN This study utilized the most recent DHS data from 2013 to 2019 of 24 different developing countries. Meta-analysis techniques were was implemented to congregate cross-sectional studies to integrate data from 24 countries to fulfill the study's objective. ParticipantsChildren's Recode (KR) data was used as this study is based on infants aged 0-11 months. RESULTS Results of this study uncovered for 24 developing countries that taking ANC and PNC had a statistically significant association in lowering infant death. These two covariates were found to significantly impact all 24 developing countries' infant mortality (OR: 0.356, 95% CI: 0.311; 0.407 for taking ANC and OR: 0.302, 95% CI: 0.243; 0.375 for taking PNC). Additionally, taking ANC was more effective in Asian countries, while taking PNC was more effective for African countries. CONCLUSION In this study, taking ANC and PNC services was significant in reducing the risk of infant mortality in developing countries. So, anticipation and advancement in health care services ought to be taken to lessen the chance of infant mortality.
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Affiliation(s)
| | - Tarana Tabassum
- Statistics Discipline, Khulna University, Khulna 9208, Bangladesh.
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Vahedi S, Torabipour A, Takian A, Mohammadpur S, Olyaeemanesh A, Kiani MM, Mohamadi E. Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study. BMC Public Health 2021; 21:457. [PMID: 33676480 PMCID: PMC7937318 DOI: 10.1186/s12889-021-10477-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran's health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. METHODS We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. RESULTS About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. CONCLUSION It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.
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Affiliation(s)
- Sajad Vahedi
- Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amin Torabipour
- Department of Health Services Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amirhossein Takian
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran. .,Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, 2nd Floor, Main Building, Poursina Ave, Tehran, Iran. .,Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), 2nd Floor, Main Building, Poursina Ave, Tehran, Iran.
| | - Saeed Mohammadpur
- Department of Health Economics, School of Management and Medical Information, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Olyaeemanesh
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran.,National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Kiani
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran.,Department of Health Management, Policy & Economics, School of Public Health, Tehran University of Medical Sciences (TUMS), 2nd Floor, Main Building, Poursina Ave, Tehran, Iran
| | - Efat Mohamadi
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran
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Peng Q, Zhang N, Yu H, Shao Y, Ji Y, Jin Y, Zhong P, Zhang Y, Wang Y, Dong S, Li C, Shi Y, Zheng Y, Jiang F, Chen Y, Jiang Q, Zhou Y. Inequalities in changing mortality and life expectancy in Jiading District, Shanghai, 2002-2018. BMC Public Health 2021; 21:303. [PMID: 33546650 PMCID: PMC7866752 DOI: 10.1186/s12889-021-10323-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improvements of population health in China have been unevenly distributed among different sexes and regions. Mortality Registration System provides an opportunity for timely assessments of mortality trend and inequalities. METHODS Causes of death were reclassified following the method of Global Burden of Disease Study (GBD). Age-standardized mortality rate (ASMR) and ring-map of the rate by town were used to describe inequalities in changing mortality. Life expectancy (LE) and cause-deleted LE were calculated on the basis of life table technique. RESULTS The burden of death from 2002 to 2018 was dominated by cardiovascular diseases (CVD), neoplasms, chronic respiratory diseases and injuries in Jiading district, accounting for almost 80% of total deaths. The overall ASMR dropped from 407.6/100000 to 227.1/100000, and LE increased from 77.86 years to 82.31 years. Women lived about 3.0-3.5 years longer than men. Besides, a cluster of lower LE was found for CVD in the southeast corner and one cluster for neoplasms in the southern corner of the district. The largest individual contributor to increment in LE was neoplasms, ranged from 2.41 to 3.63 years for males, and from 1.60 to 2.36 years for females. CONCLUSIONS Improvement in health was mainly attributed to the decline of deaths caused by CVD and neoplasms, but was distributed with sex and town. This study served as a reflection of health inequality, is conducive to formulate localized health policies and measures.
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Affiliation(s)
- Qian Peng
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Na Zhang
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong An Road, Xuhui District, Shanghai, 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Hongjie Yu
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Yueqin Shao
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Ying Ji
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Yaqing Jin
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Peisong Zhong
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Yiying Zhang
- Jiading District Center for Disease Control and Prevention, Shanghai, 201800, China
| | - Yingjian Wang
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong An Road, Xuhui District, Shanghai, 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Shurong Dong
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong An Road, Xuhui District, Shanghai, 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Chunlin Li
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong An Road, Xuhui District, Shanghai, 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Ying Shi
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong An Road, Xuhui District, Shanghai, 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Yingyan Zheng
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong An Road, Xuhui District, Shanghai, 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Feng Jiang
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong An Road, Xuhui District, Shanghai, 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Yue Chen
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Qingwu Jiang
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong An Road, Xuhui District, Shanghai, 200032, China
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China
| | - Yibiao Zhou
- Fudan University School of Public Health, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
- Key Laboratory of Public Health Safety, Fudan University, Ministry of Education, Building 8, 130 Dong An Road, Xuhui District, Shanghai, 200032, China.
- Fudan University Center for Tropical Disease Research, Building 8, 130 Dong'an Road, Xuhui District, Shanghai, 200032, China.
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Vahedi S, Ramezani-Doroh V, Shamsadiny M, Rezapour A. Decomposition of gendered socioeconomic-related inequality in outpatient health care utilization: A cross-sectional study from Iran. Int J Health Plann Manage 2021; 36:656-667. [PMID: 33420750 DOI: 10.1002/hpm.3109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/26/2020] [Accepted: 12/20/2020] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Unequal access to required health care services could deteriorate inequality in health outcomes and increase mortality and morbidity, especially among disadvantaged groups. One of the most debated factors in shaping health care inequalities is gender. This study aimed to measure and explains gendered socioeconomic-related inequality in outpatient health care utilization in Iran. METHODS This is a cross-sectional research conducted at a national level in Iran. The required data was obtained from an Iranian health care utilization household survey conducted in 2015. Erreygers Concentration Index (ECI) was used to measure the socioeconomic inequality in outpatient health care utilization. A regression-based decomposition analysis was also used to explain socioeconomic-related inequalities. RESULTS There was a significant pro-rich inequality in outpatient health care utilization between males (ECI = 0.115, SE = 0.014) and females (ECI = 0.083 SE = 0.011) indicating that utilization of these services was concentrated on the better-offs. The decomposition analysis revealed that economic status (males = 50.58%, females = 37.42%) was the main contributor to the observed inequality. Location of residence, health insurance and education were other main driver of these inequalities. CONCLUSIONS Different factors have different contribution to socioeconomic-related inequality in utilization of outpatient health care services and these could be diversified considering gender. Hence, it seems that policy makers could be able to address these inequalities effectively through gender-oriented policies.
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Affiliation(s)
- Sajad Vahedi
- Department of Health Care Management, School of Health, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Vajiheh Ramezani-Doroh
- Department of Health Management and Economic, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Shamsadiny
- Health Center of Bandar Khamir, Hormozgan University of Medical Sciences, Hormozgan, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Aguilera X, Delgado I, Icaza G, Apablaza M, Villanueva L, Castillo-Laborde C. Under five and infant mortality in Chile (1990-2016): Trends, disparities, and causes of death. PLoS One 2020; 15:e0239974. [PMID: 32997709 PMCID: PMC7526984 DOI: 10.1371/journal.pone.0239974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022] Open
Abstract
Background Child health has been a health policy priority for more than a century in
Chile. Since 2000, new health and intersectoral interventions have been
implemented. However, no recent analyses have explored child mortality and
equity in Chile, an indispensable input to guide policies towards the
achievement of the Sustainable Development Goals, specially, in the context
of a deeply unequal country such as many other Latin American countries.
Thus, the objectives of this study are to analyze the variations in the risk
and the causes of death among Chilean children aged <5 years, to identify
the determinants, and to measure inequality of infant mortality from 1990 to
2016. Materials and methods An observational study was conducted to analyze the Chilean children's
mortality from 1990 to 2016 using under five deaths and live births data
from the Vital Statistics System. To describe the variation in the risk of
death, a time series analysis was performed for each of the under five
mortality rate components. A comparative cause of death analysis was
developed for Neonatal and 1–59 months’ age groups. The determinants of
infant mortality were studied with a descriptive analysis of yearly rates
according to mother’s and child factors and bivariate logistic regression
models at the individual level. Finally, simple and complex measures of
inequality at individual level were estimated considering three-year
periods. Results Regarding under 5 mortality: (i) Child survival has improved substantially in
the last three decades, with a rapid decline in under five mortality rate
between 1990 and 2001, followed by a slower reduction; (ii) early neonatal
mortality has become the main component of the under five mortality rate
(50.6%); (iii) congenital abnormalities have positioned as the leading cause
of death; (iv) an important increase in live births below 1,000 grs.
Regarding infant mortality: (i) birth weight and gestational age are the two
most relevant risk factors in the neonatal period, while social variables
are more significant for post-neonatal mortality and, (ii) the inequality
according to mother’s education has shown a steady decline, with persistent
inequalities in post-neonatal period. Conclusions The Chilean experience illustrates child health achievements and challenges
in a country that transitioned from middle-to high-income in recent decades.
Although inequity is one of the main challenges for the country, the health
sector by granting universal access was able to reduce disparities. However,
closing the gap in post-neonatal mortality is still challenging. To overcome
stagnation in neonatal mortality, new and specific strategies must address
current priorities, emphasizing the access of vulnerable groups.
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Affiliation(s)
- Ximena Aguilera
- Centro de Epidemiología y Políticas de Salud (CEPS), Facultad de
Medicina, Universidad del Desarrollo, Santiago, Chile
- * E-mail:
| | - Iris Delgado
- Centro de Epidemiología y Políticas de Salud (CEPS), Facultad de
Medicina, Universidad del Desarrollo, Santiago, Chile
| | - Gloria Icaza
- Programa de Investigación Asociativa de Cáncer Gástrico, Instituto de
Matemática y Física, Universidad de Talca, Talca, Chile
| | - Mauricio Apablaza
- Facultad de Gobierno, Universidad del Desarrollo, Santiago,
Chile
- Oxford Poverty and Human Development Innitiative (OPHI), University of
Oxford, Oxford, United Kingdom
| | - Loreto Villanueva
- Departamento de Promoción de la Salud de la Mujer y el Recién Nacido,
Universidad de Chile, Santiago, Chile
| | - Carla Castillo-Laborde
- Centro de Epidemiología y Políticas de Salud (CEPS), Facultad de
Medicina, Universidad del Desarrollo, Santiago, Chile
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Child Health Policies from the Lens of Equality in Iran: A Qualitative Study. HEALTH SCOPE 2019. [DOI: 10.5812/jhealthscope.88314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Xu Y, Zhang T, Wang D. Changes in inequality in utilization of preventive care services: evidence on China's 2009 and 2015 health system reform. Int J Equity Health 2019; 18:172. [PMID: 31711485 PMCID: PMC6849223 DOI: 10.1186/s12939-019-1078-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/22/2019] [Indexed: 03/19/2023] Open
Abstract
Background Ensuring equal access to preventive care has always been given a priority in health system throughout world. This study aimed to decompose inequality in utilization of preventive care services into its contributing factors and then explore its changes over the period of China’s 2009–2015 health system reform. Methods The concentration index (CI) and decomposition of the CI was performed to capture income-related inequalities in preventive services utilization and identify contribution of various determinants to such inequality using data from China Health and Nutrition Survey. Then, changes in inequality from 2009 to 2015 were estimated using Oaxaca-type decomposition technique. Results The CI for preventive services utilization dropped from 0.2240 in 2009 to 0.1825 in 2015. Residential location and household income made the biggest contributions to income-related inequalities in these two years. Oaxaca decomposition revealed changes in residential location, regions and medical insurance made positive contributions to decline in inequality. However, alternation in household income, age and medical services utilization pushed the equality toward deterioration. Conclusion The pro-rich inequality in preventive healthcare services usage is evident in China despite a certain decline in such inequality during observation period. Policy actions on eliminating urban-rural and income disparity should be given the priority to equalize preventive healthcare.
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Affiliation(s)
- Yongjian Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
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19
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Understanding Changes in Socioeconomic Inequality of Unintended Pregnancy Among Iranian Married Women: A Blinder-Oaxaca Decomposition Analysis. HEALTH SCOPE 2019. [DOI: 10.5812/jhealthscope.85011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Wolde HF, Gonete KA, Akalu TY, Baraki AG, Lakew AM. Factors affecting neonatal mortality in the general population: evidence from the 2016 Ethiopian Demographic and Health Survey (EDHS)-multilevel analysis. BMC Res Notes 2019; 12:610. [PMID: 31547855 PMCID: PMC6757386 DOI: 10.1186/s13104-019-4668-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/19/2019] [Indexed: 12/15/2022] Open
Abstract
Objective This study was aimed to identify factors affecting neonatal mortality in Ethiopia. Results According to the multilevel multivariable logistic regression analysis, the odds of neonatal mortality was significantly associated with husbands with no education (AOR = 2.30, 95% CI 1.10, 4.83), female birth (AOR = 0.57, 95% CI 0.39, 0.83), twin birth (AOR = 13.62, 95% CI 7.14, 25.99), pre-term birth (AOR = 15.07, 95% CI 7.80, 29.12) and mothers with no antenatal care (ANC) visit during pregnancy (AOR = 1.90 95% CI 1.11, 3.25).
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Affiliation(s)
- Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Kedir Abdela Gonete
- Department of Human Nutrition, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adhanom Gebreegziabher Baraki
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla Lakew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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AMINI-RARANI M, RASHIDIAN A, BAYATI M, KHEDMATI MORASAE E. Estimation of a Neonatal Health Production Function for Iran: Secondary Analysis of Iran's Multiple Indicator Demographic and Health Survey 2010. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:1488-1495. [PMID: 32292732 PMCID: PMC7145914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite constant decrease in rate of neonatal mortality, the rate is still higher than that of other under-five children. One of the first steps towards reduction of neonatal mortality is to identify its determinants using health production function. The aim of the present study was to estimate neonatal health production function for Iran. METHODS In this cross-sectional study, Iranian Multiple Indicator Demographic and Health Survey (Ir-MIDHS) 2010 was used. Four categories of socioeconomic, mother, neonatal demographic and healthcare system factors were entered into the Binomial Logistic Regression model to estimate neonate health production function. Households' economic status was constructed using principal component analysis. RESULTS History of abortion/stillbirth had the highest significant positive impact on odds of neonatal mortality (odds ratio=1.98; 95 % CI=1.55-2.75), indicating that neonates of mothers with such a history had 1.98 times higher chance of death compared to other neonates. Moreover, odds ratio of neonatal death for the poorest quintiles was 1.70 (95 % CI=1.08-2.74), indicating that by moving from the poorest quintile to the richest one, the odds of being alive for neonates increased up to 70%. However, skilled birth attendant decreased the chance of death up to 58% (odds ratio=0.58; 95 % CI=0.36-0.93). CONCLUSION Considering the most significant inputs of neonatal health production function in Iran, improvement of economic status of households, provision of appropriate care services for mothers, and improvement of delivery care provided by trained personnel, could be priorities for health policymakers to act and reduce neonatal mortality in Iran.
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Affiliation(s)
- Mostafa AMINI-RARANI
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash RASHIDIAN
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Department of Information, Evidence and Research, World Health Organization, Eastern Mediterranean Region, Cairo, Egypt
| | - Mohsen BAYATI
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding Author:
| | - Esmaeil KHEDMATI MORASAE
- Center for Systems Studies, Hull University Business School (HUBS), Hull York Medical School (HYMS), University of Hull, Hull, UK
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Socio-economic inequality in unhealthy snacks consumption among adolescent students in Iran: a concentration index decomposition analysis. Public Health Nutr 2019; 22:2179-2188. [PMID: 31199208 DOI: 10.1017/s1368980019000740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The present study aimed to assess and decompose the socio-economic inequality in unhealthy snacks consumption among adolescent students in Kerman, Iran. DESIGN The data were obtained from a cross-sectional study. Principal component analysis was done to measure the socio-economic status (SES) of the adolescents' families and the normalized concentration index (NCI) was used to measure the inequality in unhealthy snacks consumption among adolescent students of different SES. The contributions of environmental and individual explanatory variables to inequality were assessed by decomposing the concentration index. SETTING Forty secondary schools of Kerman Province in Iran in 2015. PARTICIPANTS Eighth-grade adolescent students (n 1320). RESULTS The data of 1242 adolescent students were completed for the current study. Unhealthy snacks consumption was unequally distributed among adolescent students and was concentrated mainly among the high-SES adolescents (NCI = 0·179; 95 % CI 0·056, 0·119). The decomposition showed that higher SES (62 %) and receiving pocket money allowance (31 %), as environmental variables, had the highest positive contributions to the measured inequality in unhealthy snacks consumption. Taste and sensory perception (7 %) as well as cost sensitivity (5 %), as individual variables, followed them in terms of their contribution importance. CONCLUSIONS It is highly suggested that both environmental and individual factors should be addressed at different settings including schools, families and suppliers of unhealthy snacks. These findings can help future health promotion strategies in Iran to tackle the observed inequality in unhealthy snacks consumption.
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A Decomposition Analysis of Inequality in Malnutrition among Under-Five Children in Iran: Findings from Multiple Indicator Demographic and Health Survey, 2010. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:748-757. [PMID: 31110986 PMCID: PMC6500533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/30/2022]
Abstract
BACKGROUND Nutritional status at the early stages of children's lives is essential for growth and development not only in infancy but also in adult life. This study aimed to measure the inequality in malnutrition among under-five children in Iran and explore the impact of socioeconomic factors on this inequality using a regression-based decomposition approach. METHODS Data were extracted from Iran's Multiple-Indicator Demographic and Health Survey 2010. The concentration index of stunting, underweight, and wasting were applied in order to measure the magnitude of socioeconomic inequality in child malnutrition. Moreover, the concentration indices were decomposed to understand the contribution of socioeconomic variables in childhood malnutrition inequality. RESULTS The obtained concentration indices of stunting, underweight, and wasting were respectively -0.177, -0.092, and -0.031. Socioeconomic inequality in stunting and underweight was statistically significant, however this socioeconomic gradient was not observed in wasting. More than 50% of the inequality in stunting and about 63% of the inequality in underweight were influenced by socioeconomic status. Furthermore, maternal education was associated with 19% and 22% of inequality in stunting and underweight respectively. CONCLUSION The average reduction of malnutrition indices at the national level hides the burden of malnutrition among children in poor families. If government and policymakers seek to solve this problem, they have to take direct and targeted actions to eliminate the existing inequalities in the socioeconomic determinants associated with malnutrition.
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Health in Iran; 40 Years After the Islamic Revolution. SHIRAZ E-MEDICAL JOURNAL 2019. [DOI: 10.5812/semj.89606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Mutyambizi C, Booysen F, Stokes A, Pavlova M, Groot W. Lifestyle and socio-economic inequalities in diabetes prevalence in South Africa: A decomposition analysis. PLoS One 2019; 14:e0211208. [PMID: 30699173 PMCID: PMC6353159 DOI: 10.1371/journal.pone.0211208] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 01/09/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Inequalities in diabetes are widespread and are exacerbated by differences in lifestyle. Many studies that have estimated inequalities in diabetes make use of self-reported diabetes which is often biased by differences in access to health care and diabetes awareness. This study adds to this literature by making use of a more objective standardised measure of diabetes in South Africa. The study estimates socio-economic inequalities in undiagnosed diabetes, diagnosed diabetes (self-reported), as well as total diabetes (undiagnosed diabetics + diagnosed diabetics). The study also examines the contribution of lifestyle factors to diabetes inequalities in South Africa. METHODS This cross sectional study uses data from the 2012 South African National Health and Nutrition Examination Survey (SANHANES-1) and applies the Erreygers Concentration Indices to assess socio-economic inequalities in diabetes. Contributions of lifestyle factors to inequalities in diabetes are assessed using a decomposition method. RESULTS Self-reported diabetes and total diabetes (undiagnosed diabetics + diagnosed diabetics) were significantly concentrated amongst the rich (CI = 0.0746; p < 0.05 and CI = 0.0859; p < 0.05). The concentration index for undiagnosed diabetes was insignificant but pro-poor. The decomposition showed that lifestyle factors contributed 22% and 35% to socioeconomic inequalities in self-reported and total diabetes, respectively. CONCLUSION Diabetes in South Africa is more concentrated amongst higher socio-economic groups when measured using self-reported diabetes or clinical data. Our findings also show that the extent of inequality is worse in the total diabetes outcome (undiagnosed diabetics + diagnosed diabetics) when compared to the self-reported diabetes outcome. Although in comparison to other determinants, the contribution of lifestyle factors was modest, these contributions are important in the development of policies that address socio-economic inequalities in the prevalence of diabetes.
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Affiliation(s)
- Chipo Mutyambizi
- Population Health, Health Systems and Innovation, Human Sciences Research Council, Pretoria, South Africa
| | | | - Andrew Stokes
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Milena Pavlova
- Department of Health Services Research; CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Wim Groot
- Department of Health Services Research; CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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AMINI RARANI M, RASHIDIAN A, ARAB M, KHOSRAVI A, ABBASIAN E. Measuring Socioeconomic Inequality Changes in Child Mortality in Iran: Two National Surveys Inequality Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:1379-1387. [PMID: 30320013 PMCID: PMC6174055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND We aimed to measure changes in socioeconomic inequality in child mortality in Iran. METHODS A secondary data analysis of two Demographic and Health Surveys (DHS 2000 and 2010) was undertaken. Neonatal, infant and under-5 mortality rates were estimated directly from complete birth history. Economic quintiles were constructed using principal component analysis. Changes in inequality were measured using odds ratios, mortality rates, and concentration curves and indices. RESULTS Based on the compared measures, inequalities in neonatal, infant, and under-5 mortality declined between the two surveys. The poorest-to-richest neonatal, infant and under-5 mortality odds ratios in 2000 were 1.69 (95% CI= 1.3-2.07), 2.85 (95% CI= 1.96-4.1) and 1.98 (95% CI= 1.64-2.3), respectively. Whereas these mortality odds ratios in 2010 had fallen to 1.65 (95% CI= 0.95-2.9), 1.47 (95% CI=0.5-4) and 1.85 (95% CI=1.13-3), respectively. Moreover, mortality rates in all economic quintiles experienced a decreasing trend. Neonatal, infant, and under-5 mortality concentration indices in 2000 were -0.15, -0.26, and -0.17 respectively. Whereas concentration indices in 2010 had dropped to -0.13, -0.11, and -0.14, respectively. Concentration curves dominance test revealed that there was a statistically significant reduction in inequality in infant and under-5 mortalities. CONCLUSION Despite substantial reduction in child mortality rates and narrowing of the gap between poor and rich people, socioeconomic inequality in child mortalities disfavoring worse-off groups still exists. Combination of child health-related efforts that aim to reach to those children born in poor households alongside with pro-equity programs in other sectors of society may further reduce infant, under-5, and particularly neonatal mortality across economic quintiles in Iran.
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Affiliation(s)
- Mostafa AMINI RARANI
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash RASHIDIAN
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Mohammad ARAB
- Dept. of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir KHOSRAVI
- Deputy of Public Health, Ministry of Health and Medical Education, Tehran, Iran
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Omani-Samani R, Amini Rarani M, Sepidarkish M, Khedmati Morasae E, Maroufizadeh S, Almasi-Hashiani A. Socioeconomic inequality of unintended pregnancy in the Iranian population: a decomposition approach. BMC Public Health 2018; 18:607. [PMID: 29739402 PMCID: PMC5941631 DOI: 10.1186/s12889-018-5515-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 04/26/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There are several studies regarding the predictors or risk factors of unintended pregnancy, but only a small number of studies have been carried out concerning the socio-economic factors influencing the unintended pregnancy rate. This study aimed to determine the socioeconomic inequality of unintended pregnancy in Tehran, Iran, as a developing country. METHODS In this hospital based cross-sectional study, 5152 deliveries from 103 hospitals in Tehran (the capital of Iran) were included in the analysis in July 2015. Socioeconomic status (SES) was measured through an asset-based method and principal component analysis was carried out to calculate the household SES. The concentration index and curve was used to measure SES inequality in unintended pregnancy, and then decomposed into its determinants. The data was analyzed by statistical Stata software. RESULTS The Wagstaff normalized concentration index of unintended pregnancy (- 0.108 (95% Confidence Interval (CI) = - 0.119 ~ - 0.054)) endorses that unintended pregnancy is more concentrated among poorer mothers. The results showed that SES accounted for 27% of unintended pregnancy inequality, followed by the mother's nationality (19%), father's age (16%), mother's age (10%), father's education level (7%) and Body Mass Index (BMI) groups (5%). CONCLUSION Unintended pregnancy is unequally distributed among Iranian women and is more concentrated among poor women. Economic status had the most positive contribution, explaining 27% of inequality in unintended pregnancy.
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Affiliation(s)
- Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O. Box: 16635148, Tehran, Iran
| | - Mostafa Amini Rarani
- Social Determinants of Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O. Box: 16635148, Tehran, Iran
| | - Esmaeil Khedmati Morasae
- Department of Health Services Research, National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC), Institute of Psychology, Health, and Society, University of Liverpool, Liverpool, UK
| | - Saman Maroufizadeh
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O. Box: 16635148, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, P.O. Box: 16635148, Tehran, Iran
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Omani-Samani R, Mansournia MA, Almasi-Hashiani A, Sepidarkish M, Safiri S, Khedmati Morasae E, Amini Rarani M. Decomposition of socioeconomic inequalities in preterm deliveries in Tehran, Iran. Int J Gynaecol Obstet 2017; 140:87-92. [PMID: 29023698 DOI: 10.1002/ijgo.12347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/09/2017] [Accepted: 10/10/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate associations between economic inequality in preterm delivery. METHODS The present secondary analysis included cross-sectional data collected in interviews with patients following delivery at 103 hospitals in Tehran, Iran, between July 6 and 21, 2015. Principal component analysis was used to measure the socioeconomic status of participants and the concentration index was used to measure inequalities in preterm delivery among patients of different socioeconomic status. RESULTS Data were included from 5170 patients. The concentration index for preterm delivery was 0.087 (95% confidence interval 0.036-0.134), indicating that preterm deliveries were concentrated among patients with higher socioeconomic status. Higher socioeconomic status (94%), younger maternal age (29%), younger paternal age (21%), and being a homemaker (17%) had the highest positive contributions to the measured inequalities in preterm deliveries; vaginal delivery (-58%) had the highest negative contribution. CONCLUSION Preterm deliveries were distributed unequally among the study patients in Iran, and were concentrated among patients of higher socioeconomic status. Alongside future etiological studies, reproductive programs in Iran should focus on this population to redress the observed inequality.
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Affiliation(s)
- Reza Omani-Samani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Mohammad A Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Sepidarkish
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - Saeid Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
| | - Esmaeil Khedmati Morasae
- Hull University Business School (HUBS), Hull York Medical School (HYMS), University of Hull, Hull, UK
| | - Mostafa Amini Rarani
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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