National Institute of Public Health of Mali, Bamako, Mali.
Faculty of Pharmacy, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali.
J Urban Health. 2024 Nov;101(Suppl 1):57-67. doi: 10.1007/s11524-024-00931-2. Epub 2024 Nov 22.
Coverage levels of maternal and neonatal health services in Mali's major cities vary due to the combined effect of several factors, including poverty and migration to urban centers. This worsened from 2012 due to the security crisis. We conducted an analysis of the trends and differences in several indicators of maternal and neonatal care coverage in Bamako using secondary data from Mali's Demographic and Health Surveys from 2001 to 2018. Our results highlighted differential access to antenatal and childbirth care for non-poor and non-migrant women compared to their counterparts categorized as poor and migrant. The gaps were much larger depending on migration status (i.e., number of years since resettling in Bamako) and even tended to increase over time. This was particularly the case regarding the number of antenatal visits (ANC 4+), with differences according to poverty level at 7 percentage points in 2001 and 8.3 percentage points in 2018. Migration status showed even larger gaps to the disadvantage of migrant women of 13.4 percentage points (2006) and 24.4 percentage points (2018). There is a higher proportion of cesarean section among non-poor women. The results suggested an opposite pattern for postnatal care of newborns, with a difference of 6.8 percentage points of coverage in favor of the poor in 2018. The high coverage of maternal and newborn health interventions in Bamako city conceals intra-urban disparities to the detriment of poor migrant women and those who recently migrated to the city, partly due to the conflicts and security issues. A redefinition of health programs to include such targets would be desirable from an equity perspective.
马里主要城市的母婴健康服务覆盖率因多种因素的综合影响而有所不同，包括贫困和向城市中心迁移。由于安全危机，这种情况从 2012 年开始恶化。我们使用马里 2001 年至 2018 年人口与健康调查的二手数据，对巴马科母婴保健覆盖的几个指标的趋势和差异进行了分析。我们的结果突出了与被归类为贫困和移民的女性相比，非贫困和非移民女性在产前和分娩护理方面的不同获得情况。差距根据移民身份（即在巴马科重新定居的年数）而有很大差异，甚至随着时间的推移而增加。这在产前检查次数（ANC4+）方面尤为明显，2001 年和 2018 年贫困水平的差异分别为 7 个百分点和 8.3 个百分点。移民身份的差异更大，对移民妇女不利，差距为 13.4 个百分点（2006 年）和 24.4 个百分点（2018 年）。非贫困妇女中剖腹产的比例更高。新生儿产后护理的结果则呈现出相反的模式，2018 年贫困人群的覆盖率高出 6.8 个百分点。巴马科市母婴健康干预措施的高覆盖率掩盖了城市内部的差异，不利于贫困移民妇女和最近迁移到城市的移民妇女，这在一定程度上是由于冲突和安全问题。从公平的角度来看，重新定义健康计划以纳入这些目标是可取的。
