Vanke School of Public Health, Tsinghua University, Beijing, China; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Division of Health Policy & Management, College of Health Science, Korea University, Seoul, South Korea; Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul, South Korea; Harvard Center for Population and Development Studies, Cambridge, MA, United States.
Soc Sci Med. 2021 May;277:113816. doi: 10.1016/j.socscimed.2021.113816. Epub 2021 Mar 17.
To achieve Sustainable Development Goal targets related to child health and well-being, it is important to quantify inequalities in the essential child health interventions. We used the latest available Demographic and Health Surveys from 65 low-income and middle-income countries between 2005 and 2018. We examined economic-related inequalities in 15 essential child health interventions spanning across four domains: nutrition, behavioral health, household environment, and maternal factors. In the pooled analysis, we observed significant inequalities in all child health interventions, except in the use of oral rehydration therapy (ORT) for child diarrhea. The interventions with the largest adjusted difference between the richest (Q5) and the poorest (Q1) groups were in household environment domain: improved sanitation at 55.6 percentage points [PPs] (95% confidence interval [CI]: 54.7, 56.6), low indoor pollution at 43.5 PPs (95% CI: 41.4, 45.9), and safe stool disposal at 39.8 PPs (95% CI: 38.7, 41.0). In 35 countries, the adjusted difference between Q5 and Q1 groups in improved sanitation was found to be larger than 50 PPs. At the same time, country-specific analyses revealed substantial heterogeneity in the extent of inequalities in child health interventions. An inverted-U shape curve was identified between the mean intervention coverage rate and the magnitude of inequalities for household environmental and maternal interventions. This suggests an initial exacerbation of inequality in child health interventions as the coverage increases until it reaches an inflection point at which inequality begins to decline even as the coverage continues to improve. Our findings call for more systematic monitoring of economic-related inequalities in child health interventions to develop equity-oriented policies and programmes in global health.
为了实现与儿童健康和福祉相关的可持续发展目标，量化基本儿童健康干预措施方面的不平等现象非常重要。我们使用了 2005 年至 2018 年期间来自 65 个低收入和中等收入国家的最新可用人口与健康调查数据。我们考察了跨越营养、行为健康、家庭环境和产妇因素四个领域的 15 项基本儿童健康干预措施中的经济相关不平等现象。在汇总分析中，我们观察到所有儿童健康干预措施都存在显著的不平等现象，除了儿童腹泻使用口服补液疗法（ORT）的情况除外。在 richest（Q5）和 poorest（Q1）组之间调整后差异最大的干预措施是在家庭环境领域：卫生设施改善 55.6 个百分点（95%置信区间：54.7，56.6）、室内污染程度低 43.5 个百分点（95%置信区间：41.4，45.9）、安全粪便处理 39.8 个百分点（95%置信区间：38.7，41.0）。在 35 个国家，Q5 和 Q1 组之间卫生设施改善的调整后差异被发现大于 50 个百分点。同时，国家特定分析显示，儿童健康干预措施中的不平等程度存在很大的异质性。家庭环境和产妇干预措施的平均干预覆盖率与不平等程度之间呈倒 U 型曲线。这表明，随着覆盖率的增加，儿童健康干预措施中的不平等现象最初会加剧，直到达到拐点，不平等现象开始下降，即使覆盖率继续提高。我们的研究结果呼吁更系统地监测儿童健康干预措施中的经济相关不平等现象，以制定全球卫生领域的公平导向政策和方案。
