Zegeye Betregiorgis, Olorunsaiye Comfort Z, Ahinkorah Bright Opoku, Ameyaw Edward Kwabena, Seidu Abdul-Aziz, Budu Eugene, Yaya Sanni
HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia.
Department of Public Health, Arcadia University, Glenside, PA, USA.
SAGE Open Med. 2022 Apr 26;10:20503121221094688. doi: 10.1177/20503121221094688. eCollection 2022.
There is a dearth of evidence on inequalities in vitamin A supplementation in Ethiopia. The goal of this study was to assess the magnitude and overtime changes of inequalities in vitamin A supplementation among children aged 6-59 months in Ethiopia.
We extracted data from four waves of the Ethiopia Demographic and Health Surveys (2000, 2005, 2011, and 2016). The analysis was carried out using the 2019 updated World Health Organization's Health Equity Assessment Toolkit software that facilitates the use of stored data from World Health Organization's Health Equity Monitor Database. We conducted analysis of inequality in vitamin A supplementation by five equity stratifiers: household economic status, educational status, place of residence, child's sex, and subnational region. Four summary measures-population attributable fraction, ratio, difference, and population attributable risk-were assessed. We computed 95% uncertainty intervals for each point estimate to ascertain statistical significance of the observed vitamin A supplementation inequalities and overtime disparities.
The findings suggest marked absolute and relative pro-rich (population attributable fraction = 29.51, 95% uncertainty interval; 25.49-33.53, population attributable risk = 13.18, 95% uncertainty intervals; 11.38-14.98) and pro-urban (difference = 16.55, 95% uncertainty intervals; 11.23-21.87, population attributable fraction = 32.95, 95% uncertainty intervals; 32.12-33.78) inequalities. In addition, we found education-related (population attributable risk = 18.95, 95% uncertainty intervals; 18.22-19.67, ratio = 1.54, 95% uncertainty intervals; 1.37-1.71), and subnational regional (difference = 38.56, 95% uncertainty intervals; 29.57-47.54, ratio = 2.10, 95% uncertainty intervals; 1.66-2.54) inequalities that favored children from educated subgroups and those living in some regions such as Tigray. However, no sex-based inequalities were observed. While constant pattern was observed in subnational regional disparities, mixed but increasing patterns of socioeconomic and urban-rural inequalities were observed in the most recent surveys (2011-2016).
In this study, we found extensive socioeconomic and geographic-based disparities that favored children from advantaged subgroups such as those whose mothers were educated, lived in the richest/richer households, resided in urban areas, and from regions like Tigray. Government policies and programs should prioritize underprivileged subpopulations and empower women as a means to increase national coverage and achieve universal accessibility of vitamin A supplementation.
埃塞俄比亚在维生素A补充剂方面的不平等现象缺乏相关证据。本研究的目的是评估埃塞俄比亚6至59个月儿童维生素A补充剂不平等现象的程度及随时间的变化。
我们从埃塞俄比亚人口与健康调查的四轮调查（2000年、2005年、2011年和2016年）中提取数据。分析使用的是2019年更新的世界卫生组织健康公平评估工具包软件，该软件便于使用世界卫生组织健康公平监测数据库中的存储数据。我们按五个公平分层因素对维生素A补充剂的不平等情况进行了分析：家庭经济状况、教育状况、居住地点、儿童性别和次国家区域。评估了四个汇总指标——人群归因分数、比率、差异和人群归因风险。我们为每个点估计值计算了95%的不确定区间，以确定观察到的维生素A补充剂不平等现象及随时间差异的统计显著性。
研究结果表明存在明显的绝对和相对有利于富裕人群（人群归因分数=29.51，95%不确定区间：25.49 - 33.53；人群归因风险=13.18，95%不确定区间：11.38 - 14.98）和城市地区人群（差异=16.55，95%不确定区间：11.23 - 21.87；人群归因分数=32.95，95%不确定区间：32.12 - 33.78）的不平等现象。此外，我们还发现了与教育相关的不平等现象（人群归因风险=18.95，95%不确定区间：18.22 - 19.67；比率=1.54，95%不确定区间：1.37 - 1.71）以及次国家区域层面的不平等现象（差异=38.56，95%不确定区间：29.57 - 47.54；比率=2.10，95%不确定区间：1.66 - 2.54），这些不平等现象有利于来自受过教育的亚组的儿童以及生活在提格雷等一些地区的儿童。然而，未观察到基于性别的不平等现象。虽然次国家区域差异呈现出稳定模式，但在最近的调查（2011 - 2016年）中观察到社会经济和城乡不平等现象呈现出混合但不断增加的模式。
在本研究中，我们发现广泛存在基于社会经济和地理因素的差异，这些差异有利于来自优势亚组的儿童，如母亲受过教育、生活在最富裕/较富裕家庭、居住在城市地区以及来自提格雷等地区的儿童。政府政策和项目应优先考虑弱势群体，并增强妇女权能，以此提高全国范围内维生素A补充剂的覆盖率并实现普遍可及性。
