Decomposition of socioeconomic inequalities in the uptake of intermittent preventive treatment of malaria in pregnancy in Nigeria: evidence from Demographic Health Survey

Malaria Journal

Mohammad Mafizur Rahman¹  Rasheda Khanam¹  Chijioke Ifeanyi Okoli²  Mohammad Hajizadeh³ 

[1] School of Business, and Centre for Health Research, University of Southern Queensland, 4350, Toowoomba, QLD, Australia;School of Business, and Centre for Health Research, University of Southern Queensland, 4350, Toowoomba, QLD, Australia;Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria;School of Health Administration, Dalhousie University, Halifax, Canada;

关键词: Socioeconomic;    Inequalities;    Concentration index;    Decomposition analysis;    Malaria;    Intermittent preventive treatment in pregnancy;    Nigeria;   

DOI  :  10.1186/s12936-021-03834-8

来源: Springer

【 摘 要 】

BackgroundAlthough malaria in pregnancy is preventable with the use of intermittent preventive treatment with sulfadoxine–pyrimethamine (IPTp-SP), it still causes maternal morbidity and mortality, in sub-Saharan Africa and Nigeria in particular. Socioeconomic inequality leads to limited uptake of IPTp-SP by pregnant women and is, therefore, a public health challenge in Nigeria. This study aimed to measure and identify factors explaining socioeconomic inequality in the uptake of IPTp-SP in Nigeria.MethodsThe study re-analysed dataset of 12,294 women aged 15–49 years from 2018 Nigeria Demographic Health Survey (DHS). The normalized concentration index (Cn) and concentration curve were used to quantify and graphically present socioeconomic inequalities in the uptake of IPTp-SP among pregnant women in Nigeria. The Cn was decomposed to identify key factors contributing to the observed socioeconomic inequality in the uptake of adequate (≥ 3) IPTp-SP.ResultsThe study showed a higher concentration of the adequate uptake of IPTp-SP among socioeconomically advantaged women (Cn = 0.062; 95% confidence interval [CI] 0.048 to 0.076) in Nigeria. There is a pro-rich inequality in the uptake of IPTp-SP in urban areas (Cn = 0.283; 95%CI 0.279 to 0.288). In contrast, a pro-poor inequality in the uptake of IPTp-SP was observed in rural areas (Cn = − 0.238; 95%CI − 0.242 to − 0.235). The result of the decomposition analysis indicated that geographic zone of residence and antenatal visits were the two main drivers for the concentration of the uptake of IPTp-SP among wealthier pregnant women in Nigeria.ConclusionThe pro-rich inequalities in the uptake of IPTp-SP among pregnant women in Nigeria, particularly in urban areas, warrant further attention. Strategies to improve the uptake of IPTp-SP among women residing in socioeconomically disadvantaged geographic zones (North-East and North-West) and improving antenatal visits among the poor women may reduce pro-rich inequality in the uptake of IPTp-SP among pregnant women in Nigeria.

【 授权许可】

CC BY