Decomposition analysis of the compositional and contextual factors associated with poor-non-poor inequality in diarrhoea among under-five children in low- and middle-income countries

  • Public Health, Volume 193, Year 2021

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Study Justification:
– The study aimed to assess the magnitude of wealth inequalities in the development of diarrhoea among under-five children in low- and middle-income countries (LMICs).
– The study aimed to identify and quantify the contribution of contextual and compositional factors to these inequalities.
– The study aimed to provide insights into the factors driving pro-poor and pro-non-poor inequalities in diarrhoea.
Study Highlights:
– The study analyzed data from 57 Demographic and Health Surveys conducted between 2010 and 2018 in LMICs.
– Among the 57 countries, statistically significant pro-poor odds ratios were found in 29 countries, while 7 countries showed pro-non-poor inequality.
– The risk difference in diarrhoea was largest in Cameroon among countries with pro-poor inequality, and widest in Timor-Leste among countries with pro-non-poor inequality.
– Factors contributing to pro-poor inequalities in diarrhoea varied across countries, including maternal education, access to media, neighborhood socio-economic status, place of residence, birth order, and maternal age.
– The study highlighted the need for multifaceted geographically specific economic alleviation interventions to address the poor and non-poor differentials in the risk of diarrhoea, with policies tailored to country-specific risk factors.
– Further investigation is needed to understand the factors driving pro-non-poor inequalities found in 9 of the LMICs.
Recommendations for Lay Reader and Policy Maker:
– Implement targeted interventions to address the pro-poor inequalities in diarrhoea among under-five children in LMICs.
– Focus on improving maternal education, access to media, and neighborhood socio-economic status to reduce the disparities.
– Develop country-specific policies and interventions to address the contextual and compositional factors contributing to the inequalities.
– Allocate resources for multifaceted geographically specific economic alleviation interventions to reduce the risk of diarrhoea among both poor and non-poor children.
– Conduct further research to investigate the factors driving pro-non-poor inequalities in diarrhoea in LMICs.
Key Role Players:
– Researchers and academics specializing in public health and child health.
– Government officials and policymakers responsible for health and social welfare.
– Non-governmental organizations (NGOs) working in the field of child health and development.
– Community leaders and local organizations involved in healthcare delivery.
– International organizations and donors providing funding and technical support for health programs.
Cost Items for Planning Recommendations:
– Research and data collection costs for further investigation into factors driving pro-non-poor inequalities.
– Costs for developing and implementing targeted interventions, including education programs, media campaigns, and socio-economic development initiatives.
– Budget allocation for healthcare infrastructure improvement in low- and middle-income countries.
– Funding for training and capacity building of healthcare professionals and community health workers.
– Costs for monitoring and evaluation of interventions to measure their impact on reducing diarrhoea inequalities.
– Resources for collaboration and coordination among stakeholders, including government agencies, NGOs, and international organizations.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study used cross-sectional data from 57 Demographic and Health Surveys conducted between 2010 and 2018 in low- and middle-income countries (LMICs), which provides a large sample size and broad geographic coverage. The study employed descriptive statistics and Fairlie decomposition techniques with multivariable binary logistic regressions to analyze the wealth inequalities in the development of diarrhoea among under-five children. The results showed statistically significant pro-poor odds ratio in 29 countries, pro-non-poor inequality in 7 countries, and no statistically significant inequality in others. The study identified important factors responsible for pro-poor inequality, such as maternal education, access to media, neighbourhood socio-economic status, place of residence, birth order, and maternal age. However, the abstract does not provide details on the methodology used for data collection and analysis, limiting the ability to assess the study’s rigor. To improve the evidence, the abstract could include information on the sampling strategy, data quality assurance measures, and statistical methods used. Additionally, providing more context on the limitations of the study and potential sources of bias would enhance the overall strength of the evidence.

Objectives: The aim of the study was to assess the magnitude of wealth inequalities in the development of diarrhoea among under-five children in low- and middle-income countries (LMICs) and to identify and quantify contextual and compositional factors’ contribution to the inequalities. Design: This is a cross-sectional study. Methods: We used cross-sectional data from 57 Demographic and Health Surveys conducted between 2010 and 2018 in LMICs. Descriptive statistics were used to understand the gap in having diarrhoea between the children from poor and non-poor households and across the selected covariates using Fairlie decomposition techniques with multivariable binary logistic regressions at P = 0.05. Results: Of the 57 countries, we found a statistically significant pro-poor odds ratio in only 29 countries, 7 countries showed pro-non-poor inequality and others showed no statistically significant inequality. Among the countries with statistically significant pro-poor inequality, the risk difference was largest in Cameroon (94.61/1000), whereas the largest pro-non-poor risk difference in diarrhoea was widest in Timor-Leste (−41.80/1000). Important factors responsible for pro-poor inequality varied across countries. The largest contributors to the pro-poor inequalities in having diarrhoea are maternal education, access to media, neighbourhood socio-economic status, place of residence, birth order and maternal age. Conclusion: Diarrhoea remains a major challenge in most LMICs, with a wide range of pro-poor inequalities. These disparities were explained by both compositional and contextual factors, which varied widely across the countries. Thus, multifaceted geographically specific economic alleviation intervention may prove to be a potent approach for addressing the poor and non-poor differentials in the risk of diarrhoea with policies tailored to country-specific risk factors. There is a need for further investigation of factors that drive pro-non-poor inequalities found in 9 of the LMICs.

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Based on the provided description, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile health (mHealth) interventions: Develop and implement mobile applications or text messaging services to provide information and reminders about maternal health practices, such as breastfeeding, immunizations, and hygiene practices.

2. Telemedicine services: Establish telemedicine platforms that allow pregnant women in remote or underserved areas to consult with healthcare professionals, receive prenatal care, and access medical advice without the need for physical travel.

3. Community health worker programs: Expand and strengthen community health worker programs to provide education, counseling, and support to pregnant women and new mothers in their communities. This can help improve access to maternal health services and promote healthy behaviors.

4. Maternal health clinics: Establish dedicated maternal health clinics or centers in areas with limited access to healthcare facilities. These clinics can provide comprehensive prenatal care, childbirth services, and postnatal care, ensuring that pregnant women receive the necessary medical attention.

5. Financial incentives: Implement financial incentive programs to encourage pregnant women to seek and utilize maternal health services. This can include providing cash transfers, vouchers, or subsidies for transportation, medications, or healthcare services.

6. Public-private partnerships: Foster collaborations between public and private sectors to improve access to maternal health services. This can involve leveraging private sector resources, expertise, and infrastructure to expand healthcare coverage and reach underserved populations.

7. Maternal health education campaigns: Launch targeted education campaigns to raise awareness about the importance of maternal health and promote healthy behaviors during pregnancy. These campaigns can utilize various media channels, including radio, television, social media, and community outreach programs.

8. Maternal health monitoring systems: Develop and implement robust monitoring systems to track maternal health indicators and identify areas with high maternal mortality rates or poor access to healthcare. This data can inform targeted interventions and resource allocation.

9. Maternal health task forces: Establish task forces or committees dedicated to improving maternal health outcomes. These groups can bring together stakeholders from various sectors, including healthcare providers, policymakers, community leaders, and NGOs, to develop and implement strategies for enhancing access to maternal health services.

10. Maternal health infrastructure development: Invest in the development and improvement of healthcare infrastructure, including hospitals, clinics, and health centers, particularly in underserved areas. This can help ensure that pregnant women have access to quality maternal health services and facilities.

Remember, these are just potential recommendations based on the information provided. The suitability and effectiveness of these innovations may vary depending on the specific context and resources available in each country or region.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health would be to develop and implement multifaceted geographically specific economic alleviation interventions. These interventions should be tailored to address the poor and non-poor differentials in the risk of diarrhoea among under-five children in low- and middle-income countries (LMICs).

To effectively address the pro-poor inequalities in diarrhoea, the interventions should focus on the following factors identified as important contributors to the inequalities:

1. Maternal education: Enhancing access to education for mothers can empower them with knowledge and skills to prevent and manage diarrhoea in their children.

2. Access to media: Improving access to media platforms can help disseminate information about proper hygiene practices, safe water, and sanitation, which are crucial in preventing diarrhoea.

3. Neighbourhood socio-economic status: Implementing community-based interventions that target improving the socio-economic status of disadvantaged neighborhoods can help reduce the risk of diarrhoea among children.

4. Place of residence: Addressing the disparities between urban and rural areas by improving access to healthcare facilities, clean water, and sanitation in rural areas can contribute to reducing diarrhoea cases.

5. Birth order: Implementing interventions that specifically target families with higher birth order children can help address the increased risk of diarrhoea associated with higher birth order.

6. Maternal age: Providing targeted support and education to young mothers can help reduce the risk of diarrhoea in their children.

It is important to note that the factors contributing to pro-non-poor inequalities need further investigation. Therefore, additional research should be conducted to identify and understand the factors driving these inequalities in order to develop appropriate interventions.

Overall, by implementing multifaceted geographically specific economic alleviation interventions that address the identified factors, access to maternal health can be improved, leading to a reduction in diarrhoea cases among under-five children in LMICs.
AI Innovations Methodology
Based on the provided description, it seems that you are looking for innovations to improve access to maternal health. Here are a few potential recommendations:

1. Mobile Health (mHealth) Solutions: Develop and implement mobile applications or text messaging services to provide pregnant women with important health information, reminders for prenatal care appointments, and access to teleconsultations with healthcare providers.

2. Community Health Workers (CHWs): Train and deploy CHWs in rural and underserved areas to provide maternal health education, antenatal care, and postnatal support. CHWs can also help identify high-risk pregnancies and refer women to appropriate healthcare facilities.

3. Telemedicine: Establish telemedicine platforms to enable remote consultations between pregnant women and healthcare providers. This can help overcome geographical barriers and improve access to specialized care, especially in areas with limited healthcare facilities.

4. Maternal Health Vouchers: Implement voucher programs that provide pregnant women with financial assistance to access essential maternal health services, such as antenatal care, skilled birth attendance, and postnatal care.

To simulate the impact of these recommendations on improving access to maternal health, a possible methodology could include the following steps:

1. Define the indicators: Identify key indicators to measure access to maternal health, such as the number of antenatal care visits, skilled birth attendance rates, postnatal care utilization, and maternal mortality rates.

2. Data collection: Gather relevant data on the selected indicators from various sources, including national health surveys, health facility records, and existing research studies.

3. Baseline assessment: Analyze the current state of access to maternal health services using the collected data. This will serve as a baseline for comparison.

4. Introduce the recommendations: Simulate the implementation of the recommended innovations by incorporating their potential effects on the selected indicators. This can be done through mathematical modeling or statistical analysis.

5. Impact assessment: Compare the simulated outcomes with the baseline assessment to determine the potential impact of the recommendations on improving access to maternal health. Evaluate changes in the selected indicators and assess the magnitude of improvement.

6. Sensitivity analysis: Conduct sensitivity analysis to explore the robustness of the results by varying key parameters and assumptions used in the simulation.

7. Policy implications: Based on the findings, provide recommendations for policy-makers and stakeholders on the most effective strategies to improve access to maternal health, considering the simulated impact of the recommended innovations.

It is important to note that the methodology may vary depending on the available data, resources, and specific research objectives.


Statistics:
Citations: 6
Identifiers:
DOI: 10.1016/j.puhe.2020.12.009
ISSN: 00333506
Research Areas:
Community Interventions, Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants
Study Countries:
Cameroon
Study Design:
Case-Control Study, Cross Sectional Study, randomised-control-trial
Study Approach:
Quantitative
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