Souaibou Moussa, Sandie Arsène Brunelle, Barros Aluisio J D, Dzossa Anaclet Désiré, Sidze Estelle Monique
National Institute of Statistics, Rue 3025, Quartier du Lac, P.O Box 134, Yaounde, Cameroon.
Muso Health, 3254 19th Street, 2nd Floor, San Francisco, CA 94110, United States.
BMC Health Serv Res. 2025 Sep 9;25(1):1193. doi: 10.1186/s12913-025-13393-2.
Maternal healthcare (MHC) in Cameroon reflects the persistent challenges in Sub-Saharan Africa, where high maternal mortality continues despite improved service utilization, stressing inequitable effective coverage (EC). This study applied EC cascade analysis-including service contact, continuity, and input-adjusted coverage-to quantify geographic and socioeconomic disparities, informing equity-focused strategies to dismantle structural barriers in the MHC continuum.
We combined population and health facility data (2018 Cameroon Demographic and Health Survey and 2015 Emergency Obstetric and Neonatal Care Assessment) to estimate the input-adjusted coverage of antenatal care (ANC) and intra-and postpartum care (IPC). Inequalities were assessed using absolute and relative measures.
The MHC cascade showed significant falls in input-adjusted coverage. For ANC, 86.3% service contact eroded to 25.3% continuity and 14.4% input-adjusted coverage. For IPC, the service continuum dropped from 51.4 to 31.4% input-adjusted coverage, revealing steeper losses compared to ANC (20.0% vs. 10.9%). When accounting for service readiness, relative inequalities intensified (e.g., the wealth-based RII for ANC increased by 122%), while absolute gaps narrowed (SII declined by 25%), indicating a greater loss of coverage among socioeconomically privileged groups (IPC input-adjusted coverage dropped by 20.9% for the highest quintile vs. 11.1% for the lowest quintile). At the same time, marginalized populations experienced compounded exclusion-facing severely limited access to care and substandard service quality at available facilities-highlighting the critical need to improve both access and quality.
Cameroon's MHC disparities stem from systemic resource and quality gaps. Integrating absolute and relative inequality metrics into policy frameworks can dismantle structural biases, aligning interventions with continuum-of-care strategies to prevent avoidable mortality.
喀麦隆的孕产妇保健（MHC）反映了撒哈拉以南非洲地区持续存在的挑战，尽管服务利用率有所提高，但孕产妇死亡率仍然居高不下，这凸显了有效覆盖范围（EC）的不公平性。本研究应用了EC级联分析，包括服务接触、连续性和投入调整后的覆盖率，以量化地理和社会经济差异，为以公平为重点的战略提供信息，以消除MHC连续体中的结构性障碍。
我们结合了人口和卫生设施数据（2018年喀麦隆人口与健康调查和2015年紧急产科和新生儿护理评估），以估计产前护理（ANC）以及产时和产后护理（IPC）的投入调整后的覆盖率。使用绝对和相对指标评估不平等情况。
MHC级联显示投入调整后的覆盖率显著下降。对于ANC，86.3%的服务接触率降至25.3%的连续性和14.4%的投入调整后的覆盖率。对于IPC，服务连续性从51.4%降至31.4%的投入调整后的覆盖率，与ANC相比下降幅度更大（20.0%对10.9%）。在考虑服务准备情况时，相对不平等加剧（例如，ANC基于财富的相对不平等指数增加了122%），而绝对差距缩小（SII下降了25%），这表明社会经济特权群体的覆盖率损失更大（最高五分位数的IPC投入调整后的覆盖率下降了20.9%，而最低五分位数为11.1%）。与此同时，边缘化人群面临着多重排斥——在现有设施中获得护理的机会极为有限，服务质量也不合格——这凸显了改善可及性和质量的迫切需求。
喀麦隆的MHC差异源于系统性的资源和质量差距。将绝对和相对不平等指标纳入政策框架可以消除结构性偏见，使干预措施与连续护理战略保持一致，以预防可避免的死亡。
