Murendo Conrad
Save the Children International, Qalai Fatullah, PD 10, Kabul, Afghanistan.
BMC Health Serv Res. 2025 Jan 11;25(1):57. doi: 10.1186/s12913-025-12205-x.
This study examined the wealth-related inequality in women healthcare seeking behaviour for under-five children illness in Afghanistan and its determinants.
Data of 32409 mothers/caregivers of children under-five were extracted from Afghanistan Multiple Indicator Cluster Survey conducted in 2022. Wealth-related inequalities in women healthcare seeking behaviour for under-five children illness was investigated using Erreygers and Wagstaff concentration indices and curve. Contributions of selected factors to the total inequality were estimated using the Erreygers decomposition technique.
The Erreygers and Wagstaff normalized concentration indices for women healthcare seeking behaviour for under-five children illness was 0.040; p < 0.000 and 0.042; p < 0.000 respectively. Hence, women healthcare seeking behaviour for children under-five illness was heavily concentrated among women from richer households and disfavoured women from poorer households. The decomposition findings revealed that household wealth (265%), residency in rural areas (-125%), access to mobile phone (-83%), access to internet (67%) and mothers' education (26%) were the major determinants of pro-rich inequalities.
Policy makers, the private and development actors in Afghanistan should promote inclusive income generation interventions and healthcare awareness programmes, including women from poor households to eliminate wealth-related inequalities in women healthcare seeking behaviour. There is need for decentralizing health facilities in both rural and urban areas to improve equitable access to healthcare services. There is scope for disseminating health education through mobile phones and internet, reaching out to all areas to improve knowledge on children's illnesses and subsequently reduce inequalities in women health seeking behaviours.
本研究调查了阿富汗五岁以下儿童患病时,妇女就医行为中与财富相关的不平等现象及其决定因素。
从2022年进行的阿富汗多指标类集调查中提取了32409名五岁以下儿童的母亲/照料者的数据。使用埃雷格斯(Erreygers)和瓦格斯塔夫(Wagstaff)浓度指数及曲线,研究了五岁以下儿童患病时妇女就医行为中与财富相关的不平等现象。使用埃雷格斯分解技术估算了选定因素对总不平等的贡献。
五岁以下儿童患病时妇女就医行为的埃雷格斯和瓦格斯塔夫标准化浓度指数分别为0.040;p<0.000和0.042;p<0.000。因此,五岁以下儿童患病时妇女的就医行为主要集中在富裕家庭的妇女中,而贫困家庭的妇女则处于劣势。分解结果显示,家庭财富(265%)、农村居住情况(-125%)、手机使用情况(-83%)、互联网使用情况(67%)和母亲教育程度(26%)是有利于富人的不平等现象的主要决定因素。
阿富汗的政策制定者、私营部门和发展行为体应推动包容性创收干预措施和医疗保健意识方案,将贫困家庭的妇女纳入其中,以消除妇女就医行为中与财富相关的不平等现象。有必要在农村和城市地区分散卫生设施,以改善医疗服务的公平获取。有机会通过手机和互联网传播健康教育,覆盖所有地区,以提高对儿童疾病的认识,进而减少妇女就医行为中的不平等现象。