Examining the Urban advantage in maternal health care in developing countries

Although recent survey data make it possible to examine inequalities in maternal and newborn health care in developing countries, analyses have not tended to take into consideration the special nature of urban poverty. Using improved methods to measure urban poverty in 30 countries, we found substantial inequalities in maternal and newborn health, and in access to health care. The ‘‘urban advantage’’ is, for some, non-existent. The urban poor do not necessarily have better access to services than the rural poor, despite their proximity to services. There are two main patterns of urban inequality in developing countries: (1) massive exclusion, in which most of the population do not have access to services, and (2) urban marginalisation, in which only the poor are excluded. At a country level, these two types of inequality can be further subdivided on the basis of rural access levels. Inequity is not mandatory. Patterns of health inequality differ with context, and there are examples of countries with relatively small degrees of urban inequity. Women and their babies need to have access to care, especially around the time of birth. Different strategies to achieve universal coverage in urban areas are needed according to urban inequality typology, but the evidence for what works is restricted to a few case studies

Resurrecting the interval of need concept to improve dialogue between researchers, policymakers, and social care practitioners

Academics, social care practitioners, and policymakers speak different languages. If academic research is to have an impact on society, it must be understandable and convincing to the end users. We argue that the conceptualisation of social care ‘need’ is different among these stakeholders, leading to poor communication between them. Academics should use concepts that have more meaning to practitioners. We propose resurrecting a little-used concept from the 1970s, ‘interval of need’, to help to bridge this gap. The interval of need concept identifies how often people require help, supplementing the usual data about types of tasks where assistance is needed. The history of the concept is described, followed by a test of its usefulness for today’s researchers by applying it to data from the English Longitudinal Study of Ageing. An updated version of interval of need is proposed. Validation checks were conducted against mortality data, and through conceptual validation from a social work practitioner. The nature of the dataset limited comparability with previous studies. However, we conclude that the interval of need concept has promising scope to enhance communication of research findings, potentially leading to improved outcomes for service users. This paper strives to mark a turning point in the language and analysis of social care, ensuring that academic investigation in this field is convincing and clear to practitioners and policymakers

The impact of multi-morbidity on disability among older adults in South Africa: do hypertension and socio-demographic characteristics matter?

Background: Alongside the global population ageing phenomenon, there has been a rise in the number of individuals who suffer from multiple chronic conditions. Taking the case of South Africa, this study aims, first, to investigate the association between multi-morbidity and disability among older adults; and second, to examine whether hypertension (both diagnosed and undiagnosed) mediates this relationship. Lastly, we consider whether the impact of the multi-morbidity on disability varies by socio-demographic characteristics. Methods: Data were drawn from Wave 1 (2007-08) of the South African Study on Global Ageing and Adult Health. Disability was measured using the 12-item World Health Organisation Disability Assessment Schedule (WHODAS) 2.0. Scores were transformed into a binary variable whereby those over the 90th percentile were classified as having a severe disability. The measure of multi-morbidity was based on a simple count of self-reported diagnosis of selected chronic conditions. Self-reports of diagnosed hypertension, in addition to blood pressure measurements at the time of interview, were used to create a three category hypertension variable: no hypertension (diagnosed or measured), diagnosed hypertension, hypertension not diagnosed but hypertensive measured blood pressure. Interactions between the number of chronic diseases with sex, ethnicity and wealth were tested. Logistic regression was used to analyze the relationships. Results: 25.4% of the final sample had one and 13.2% two or more chronic diseases. Nearly half of the respondents had a hypertensive blood pressure when measured during the interview, but had not been previously diagnosed. A further third self-reported they had been told by a health professional they had hypertension. The logistic regression showed in comparison to those with no chronic conditions, those with one or two or more had significantly higher odds of severe disability. Hypertension was insignificant and did not change the direction or size of the effect of the multi-morbidity measure substantially. The interactions between number of chronic conditions with wealth were significant at the 5% level. Conclusions: The diagnosis of multiple chronic conditions, can be used to identify those most at risk of severe disability. Limited resources should be prioritized for such individuals in terms of preventative, rehabilitative and palliative care

Examining the “Urban Advantage” in Maternal Health Care in Developing Countries

Andrew Channon and colleagues outline the complexities of urban advantage in maternal health where the urban poor often have worse access to health care than women in rural areas

Socioeconomic risk factors for labour induction in the United Kingdom

ObjectivesLabour induction is a childbirth intervention experienced by a growing number of women globally each year. While the maternal and socioeconomic indicators of labour induction are well documented in countries like the United States, considerably less research has been done into which women have a higher likelihood of labour induction in the United Kingdom. This paper explores the relationship between labour induction and maternal demographic, socioeconomic, and health indicators by parity in the United Kingdom.MethodLogistic regression analyses were conducted using the first sweep of the Millennium Cohort Study, including a wide range of socioeconomic factors such as maternal educational attainment, marital status, and electoral ward deprivation, in addition to maternal and infant health indicators. ResultsMultiparous women with fewer educational qualifications and those living in disadvantaged places had a greater likelihood of labour induction than women with higher qualifications and women in advantaged electoral wards. There were no significant associations between educational qualifications and induction of labour in nulliparous women.ConclusionsThis paper highlights which UK women are at higher risk of labour induction and how this risk varies by socioeconomic status, demonstrating that less advantaged women are more likely to experience labour induction. This evidence could help health care professionals identify which patients may be at higher risk of childbirth intervention.<br/

The effect of the local environment on child nutritional outcomes: how does seasonality relate to wasting amongst children under 5 in south-west coastal Bangladesh?

The impact of short-term environmental changes on child nutritional status is not constant within populations. In many countries, the seasons are closely linked with many factors that are known to affect nutritional outcomes, such as food consumption, crop harvests, employment opportunities and illness. With extreme seasonal variation becoming more common, understanding how seasonality is related to child nutritional outcomes is vital. This study will explore spatial and temporal variation and determinants for acute malnutrition in a coastal river delta in south-west Bangladesh over the period of a year. Using a rural longitudinal survey, conducted in 2014–15 with 3 survey waves, wasting amongst children under 5 was studied. Spatial variation was analysed through ‘socio-ecological systems’, which capture interactions between ecosystems, livelihoods and populations. Wasting prevalence varied from 18.2% in the monsoon season to 8.7% post-major rice harvest (Aman). Seasons did not relate to wasting consistently over socio-ecological systems, with some systems showing greater variability over time, highlighting distinct seasonal dynamics in nutritional status. Wealthier socio-ecological systems had lower wasting generally, as expected, with greater livelihood diversification opportunities and strategies to smooth consumption. Nutrition interventions must consider seasonal peaks in acute malnutrition, as well as the environmental context when implementing programmes to maximise effectiveness. With increasing variability in seasonal changes, inequalities in the impact of season must be accounted for in health promotion activities. Furthermore, timing and season of survey implementation is an important factor to be accounted for in nutrition research, especially when comparing between two cross-sectional surveys

What is the private sector? Understanding private provision in the health systems of low-income and middle-income countries.

Private health care in low-income and middle-income countries is very extensive and very heterogeneous, ranging from itinerant medicine sellers, through millions of independent practitioners—both unlicensed and licensed—to corporate hospital chains and large private insurers. Policies for universal health coverage (UHC) must address this complex private sector. However, no agreed measures exist to assess the scale and scope of the private health sector in these countries, and policy makers tasked with managing and regulating mixed health systems struggle to identify the key features of their private sectors. In this report, we propose a set of metrics, drawn from existing data that can form a starting point for policy makers to identify the structure and dynamics of private provision in their particular mixed health systems; that is, to identify the consequences of specific structures, the drivers of change, and levers available to improve efficiency and outcomes. The central message is that private sectors cannot be understood except within their context of mixed health systems since private and public sectors interact. We develop an illustrative and partial country typology, using the metrics and other country information, to illustrate how the scale and operation of the public sector can shape the private sector’s structure and behaviour, and vice versa

Prevalence and correlates of sex-selective abortions and missing girls in Nepal: evidence from the 2011 Population Census and 2016 Demographic and Health Survey

Objectives: these were to: (1) produce national and subnational estimates of the sex ratio at birth (SRB) and number of missing girl births in Nepal and (2) understand the socioeconomic correlates of these phenomena.Design: observational secondary data analysis of (1) the 2011 population census of Nepal and (2) the Nepal Demographic and Health Survey (DHS) 2006, 2011 and 2016.Setting: Nepal.Participants: (1) 2 567 963 children age 0–4 in the 2011 population census and (2) 27 329 births recorded in DHSs.Primary and secondary outcomes: we estimate the SRB, and number and proportion of missing girls in the year and 5 years before the census by district. We also calculate conditional sex ratios (the SRB dependant on parity and sex of previous children) by province, time, education and wealth.Results: we find that 11 districts have significantly skewed sex ratios at birth in the 2011 population census, with the highest SRBs observed in Arghakhanchi (SRB=127) and Bhaktapur (SRB=123). 22 540 girl births were missing in the 5 years before the 2011 population census. Sex-selective abortion is geographically concentrated, especially in the Kathmandu Valley and Lumbini Province, with 53% of missing girls found in only 11 out of 75 districts.DHS data confirm this, with elevated conditional sex ratios observed in Bagmati and Lumbini Provinces; conditional sex ratios where previous births were all female also became more skewed over time. Skewed sex ratios are concentrated among wealthier more educated groups.Conclusions: it is clear that sex selection will persist and develop in Nepal unless a coordinated effort is made to address both the demand for and supply of this service. Policies should be holistic and encompass economic and legal gender equity, and strengthen monitoring mechanisms to prevent technology misuse, without jeopardising the right to safe, free and legal abortion