A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt.

BACKGROUND: The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care. METHODS: Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private). RESULTS: While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources. CONCLUSIONS: Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term

Improving the energy efficiency in historic building stocks: assessment of a restoration compatibility score

The improvement of the energy efficiency of building stocks mostly consisting of heritage-listed buildings is a crucial issue from the environmental and economic points of view. However, the related interventions must take into account the non-monetary value due to their importance in the field of heritage preservation. As such, the interventions must be compatible with restoration principles aimed at preserving the main characteristics of the building (dimensions, materials and aspect). Moreover, when Institutions and large Companies act on large building stocks, they need procedures and decision tools able to define the most convenient set of interventions dedicated to each building. In such a context, it is very useful to merge restoration compatibility with energy (and, consequently, economic) assessments. This paper shows the results coming from the application of such an approach, by tracking the main steps of the following procedure and by showing its main advantages. In particular, we evaluate the compatibility of retrofit interventions through the assessment of a restoration compatibility score, which comes from a multi-criteria procedure