Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Interfaculty Program in Public Health, Western University, London, ON, Canada.
Int J Public Health. 2023 Jun 2;68:1605457. doi: 10.3389/ijph.2023.1605457. eCollection 2023.
(a) To quantify the level and changes in socioeconomic inequality in the utilization of antenatal care (ANC), institutional delivery (ID) and postnatal care (PNC) in Nepal over a 20-year period; (b) identify key drivers of inequality using decomposition analysis; and (c) identify geographical clusters with low service utilization to inform policy. Data from the most recent five waves of the Demographic Health Survey were used. All outcomes were defined as binary variables: ANC (=1 if ≥4 visits), ID (=1 if place of delivery was a public or private healthcare facility), and PNC (=1 if ≥1 visits). Indices of inequality were computed at national and provincial-level. Inequality was decomposed into explanatory components using Fairile decomposition. Spatial maps identified clusters of low service utilization. During 1996-2016, socioeconomic inequality in ANC and ID reduced by 10 and 23 percentage points, respectively. For PND, the gap remained unchanged at 40 percentage points. Parity, maternal education, and travel time to health facility were the key drivers of inequality. Clusters of low utilization were displayed on spatial maps, alongside deprivation and travel time to health facility. Inequalities in the utilization of ANC, ID and PNC are significant and persistent. Interventions targeting maternal education and distance to health facilities can significantly reduce the gap.
(a) 量化尼泊尔在 20 年内产前护理 (ANC)、机构分娩 (ID) 和产后护理 (PNC) 利用方面的社会经济不平等程度和变化；(b) 使用分解分析确定不平等的主要驱动因素；(c) 确定服务利用率低的地理集群，为政策提供信息。数据来自最近五次人口健康调查的结果。所有结果均定义为二进制变量：ANC（=1，如果≥4 次就诊）、ID（=1，如果分娩地点是公共或私人医疗保健机构）和 PNC（=1，如果≥1 次就诊）。不平等指数在国家和省级层面进行计算。使用公平分解法将不平等分解为解释性组成部分。空间图确定了服务利用率低的集群。1996 年至 2016 年间，ANC 和 ID 的社会经济不平等程度分别降低了 10%和 23%。对于 PND，差距保持在 40%不变。胎次、产妇教育和前往医疗机构的时间是不平等的主要驱动因素。低利用率集群与贫困和前往医疗机构的时间一起显示在空间地图上。 ANC、ID 和 PNC 的利用率不平等是显著且持续存在的。针对产妇教育和距离医疗机构的干预措施可以显著缩小差距。
