there are still wide coverage gaps for important maternal and child
health interventions among Countdown countries, even though they have
made some progress since 1990. J Ties Boerma (WHO, Geneva, Switzerland)
and colleagues from the Countdown 2008 Equity Analysis Group also found
that in order to reach Millennium Development Goals (MDG) 4 and 5, the
rate of progress would have to be more than doubled.
To reach these conclusions, researchers analyzed household survey data
acquired between 1990 and 2006 for 54 Countdown countries. They used
the data on four intervention areas - family planning, maternal and
newborn care, immunization, and treatment of sick children - to create
an aggregate coverage index with each intervention equally weighted.
The coverage gap - the percentage of the population that does not
receive treatment coverage - averaged about 43% for the most recent
surveys of the 54 countries. Less than 20% of people in Tajikistan and
Peru did not receive coverage, and more than 70% in Ethiopia and Chad
received no treatment coverage. The researchers also found notable
differences in the size of the coverage gap between relatively poor and
wealthy countries. The mean coverage gap was 54% for the poorest fifth
of the population and 29% for the richest fifth. The differences in
between poor and wealthy countries were most pronounced in the maternal
and newborn health interventions and smallest in the immunization
intervention area.
Forty of the countries had more than one survey and demonstrated a
coverage gap decrease by 0.9% per year since the early 1990s. Only
three countries after 1995 had coverage gap decreases greater than 2%
per year - Cambodia, Mozambique, and Nepal. Lastly, patterns of
inequality remained as expected. In countries with lower overall
coverage, richer people had high coverage rates; and in countries with
higher overall coverage, poorer people had low coverage rates.
"Most countdown countries have made gradual progress in reducing the
coverage gap for key interventions since 1990. The coverage gaps,
however, are still very wide and the pace of decline needs to be more
than doubled to make significant progress in the years between now and
2015 to reach levels of coverage of these and other interventions
needed for MDG4 and 5," conclude the authors.
Mind the gap: equity and trends in coverage of maternal, newborn, and
child health services in 54 Countdown countries
Countdown 2008 Equity Analysis Group
The Lancet (2008). 371[9620]:1259-67.
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: Peter M Crosta
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