Temporal trends in spatial inequalities of maternal and newborn health services among four east African countries, 1999-2015

Sub-Saharan Africa continues to account for the highest regional maternal mortality ratio (MMR) in the world, at just under 550 maternal deaths per 100,000 live births in 2015, compared to a global rate of 216 deaths. Spatial inequalities in access to life-saving maternal and newborn health (MNH) se...

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Bibliographic Details
Published in:	BMC public health Vol. 18; no. 1; pp. 1339 - 13
Main Authors:	Ruktanonchai, Corrine W, Nilsen, Kristine, Alegana, Victor A, Bosco, Claudio, Ayiko, Rogers, Seven Kajeguka, Andrew C, Matthews, Zöe, Tatem, Andrew J
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 04-12-2018 BioMed Central BMC
Subjects:	Antenatal care Bayesian analysis Births Demographics Developing countries East Africa community Estimates Fatalities Health care disparities Health disparities Health services Inequalities Infant health services LDCs Lifesaving Maternal & child health Maternal and newborn health Maternal health services Maternal mortality Newborn babies Obstetrics Postpartum period Prenatal care Public health Skilled birth attendance Socioeconomic factors Spatial interpolation Sustainable development Temporal analysis Trends Sub-Saharan Africa Africa Rwanda Tanzania Uganda Kenya East Africa Temporal analysis Antenatal care East Africa community Maternal and newborn health Spatial interpolation Skilled birth attendance Postnatal care
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Summary:	Sub-Saharan Africa continues to account for the highest regional maternal mortality ratio (MMR) in the world, at just under 550 maternal deaths per 100,000 live births in 2015, compared to a global rate of 216 deaths. Spatial inequalities in access to life-saving maternal and newborn health (MNH) services persist within sub-Saharan Africa, however, with varied improvement over the past two decades. While previous research within the East African Community (EAC) region has examined utilisation of MNH care as an emergent property of geographic accessibility, no research has examined how these spatial inequalities have evolved over time at similar spatial scales. Here, we analysed temporal trends of spatial inequalities in utilisation of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) among four East African countries. Specifically, we used Bayesian spatial statistics to generate district-level estimates of these services for several time points using Demographic and Health Surveys data in Kenya, Tanzania, Rwanda, and Uganda. We examined temporal trends of both absolute and relative indices over time, including the absolute difference between estimates, as well as change in performance ratios of the best-to-worst performing districts per country. Across all countries, we found the greatest spatial equality in ANC, while SBA and PNC tended to have greater spatial variability. In particular, Rwanda represented the only country to consistently increase coverage and reduce spatial inequalities across all services. Conversely, Tanzania had noticeable reductions in ANC coverage throughout most of the country, with some areas experiencing as much as a 55% reduction. Encouragingly, however, we found that performance gaps between districts have generally decreased or remained stably low across all countries, suggesting countries are making improvements to reduce spatial inequalities in these services. We found that while the region is generally making progress in reducing spatial gaps across districts, improvement in PNC coverage has stagnated, and should be monitored closely over the coming decades. This study is the first to report temporal trends in district-level estimates in MNH services across the EAC region, and these findings establish an important baseline of evidence for the Sustainable Development Goal era.
ISSN:	1471-2458 1471-2458
DOI:	10.1186/s12889-018-6241-8