University of Kara, Faculty of Economics and Management (FaSEG), Kara, Togo.
The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
Int J Equity Health. 2020 Aug 25;19(1):143. doi: 10.1186/s12939-020-01258-5.
Inequality of opportunity in health and nutrition is a major public health issue in the developing regions. This study analyzed the patterns and extent of inequality of opportunity in health and nutrition among children under-five across three countries sub-Saharan Africa with low Human development index (HDI).
We used data from the Multiple Indicator Cluster Survey of the Democratic Republic of Congo (20,792 households, 21,756 women aged 15 to 49 and 21,456 children under five), Guinea Bissau (6601 households, 10,234 women aged 15-49 and 7573 children under five) and Mali (11,830 households, 18,409 women in 15-49 years and 16,468 children under five) to compute the human opportunity index (HOI) and the dissimilarity index (D-index). Secondly, the Shapley decomposition method was used to estimate the relative contribution of circumstances that are beyond the control of children under-five and affecting their development outcomes in later life stages.
The study revealed that children belonging to the most favorable group had higher access rates for immunization (93.64%) and water and sanitation facilities (73.59%) in Guinea Bissau. In Congo DR, the access rate was high for immunization (93.9%) for children in the most favorable group. In Mali, access rates stood at 6.56% for children in the most favorable group. In Guinea Bissau, the inequality of opportunity was important in access to health services before and after delivery (43.85%). In Congo DR, the inequality of opportunity was only high for the immunization composite indicator (83.79%) while in Mali, inequality of opportunity was higher for access to health services before and after delivery (41.67%).
The results show that there are efforts in some places to promote access to health and nutrition services in order to make access equal without distinction linked to the socio-economic and demographic characteristics in which the children live. However, the inequalities of opportunity observed between the children of the most favorable group and those of the least favorable group, remain in general at significant levels and call on government of these countries to implement policies taking them into account.
在发展中地区，健康和营养方面的机会不平等是一个主要的公共卫生问题。本研究分析了撒哈拉以南非洲三个人类发展指数（HDI）较低的国家 5 岁以下儿童健康和营养方面机会不平等的模式和程度。
我们使用了来自刚果民主共和国（20792 户家庭，21756 名 15 至 49 岁的妇女和 21456 名 5 岁以下儿童）、几内亚比绍（6601 户家庭，10234 名 15-49 岁的妇女和 7573 名 5 岁以下儿童）和马里（11830 户家庭，18409 名 15-49 岁的妇女和 16468 名 5 岁以下儿童）多指标类集调查的数据来计算人类机会指数（HOI）和不相似指数（D-index）。其次，使用 Shapley 分解方法来估计超出儿童控制范围并影响其后期生活阶段发展结果的情况的相对贡献。
研究表明，属于最有利群体的儿童在几内亚比绍更有可能获得免疫接种（93.64%）和水和卫生设施（73.59%）。在刚果民主共和国，最有利群体的儿童获得免疫接种的比例很高（93.9%）。在马里，最有利群体的儿童获得免疫接种的比例为 6.56%。在几内亚比绍，在分娩前后获得卫生服务的机会不平等程度很高（43.85%）。在刚果民主共和国，机会不平等仅在免疫综合指标方面很高（83.79%），而在马里，在分娩前后获得卫生服务的机会不平等程度更高（41.67%）。
结果表明，在一些地方，为促进获得卫生和营养服务方面做出了努力，以便在没有区别的情况下促进获得服务，而不考虑儿童所处的社会经济和人口特征。然而，观察到的最有利群体和最不利群体之间的机会不平等总体上仍然处于显著水平，呼吁这些国家的政府考虑实施相关政策。
