The Role of Gender Inequality and Health Expenditure on the Coverage of Demand for Family Planning Satisfied by Modern Contraceptives: A Multilevel Analysis of Cross-Sectional Studies in 14 LAC Countries

BACKGROUND: Despite international efforts to improve reproductive health indicators, little attention is paid to the contributions of contextual factors to modern contraceptive coverage, especially in the Latin America and the Caribbean (LAC) region. This study aimed to identify the association between country-level Gender Inequality and Health Expenditure with demand for family planning satisfied by modern contraceptive methods (DFPSm) in Latin American sexually active women. METHODS: Our analyses included data from the most recent (post-2010) Demographic and Health Survey or Multiple Indicator Cluster Survey from 14 LAC countries. Descriptive analyses and multilevel logistic regressions were performed. Six individual-level factors were included. The effect of the country-level factors Gender Inequality Index (GII) and Current Health Expenditure on DFPSm was investigated. FINDINGS: DFPSm ranged from 41.8% (95% CI: 40.2-43.5) in Haiti to 85.6% (95% CI: 84.9-86.3) in Colombia, with an overall median coverage of 77.8%. A direct association between the odds of DFPSm and woman\u27s education, wealth index, and the number of children was identified. Women from countries in the highest GII tertile were less likely (OR: 0.32, 95% CI: 0.13-0.76) to have DFPSm than those living in countries in the lowest tertile. INTERPRETATION: Understanding the contribution of country-level factors to modern contraception may allow macro-level actions focused on the population\u27s reproductive needs. In this sense, country-level gender inequalities play an important role, as well as individual factors such as wealth and education. FUNDING: Bill and Melinda Gates Foundation and Associação Brasileira de Saúde Coletiva (ABRASCO)

COVID-19 and social distancing among children and adolescents in Brazil

OBJECTIVE To estimate the prevalence of SARS-CoV-2 antibodies and the adherence to measures of social distancing in children and adolescents studied in three national surveys conducted in Brazil between May–June 2020. METHODS Three national serological surveys were conducted in 133 sentinel cities located in all 27 Federative Units. Multistage probability sampling was used to select 250 individuals per city. The total sample size in age ranges 0–9 and 10–19 years old are of 4,263 and 8,024 individuals, respectively. Information on children or adolescents was gathered with a data collection app, and a rapid point-of-case test for SARS-CoV-2 was conducted on a finger prick blood sample. RESULTS The adjusted prevalence of antibodies was 2.9% (2.2–3.6) among children 0–9 years, 2.2% (1.8–2.6) among adolescents 10-19 years, and 3.0% (2.7–3.3) among adults 20+years. Prevalence of antibodies was higher among poor children and adolescents compared to those of rich families. Adherence to social distancing measures was seen in 72.4% (71.9–73.8) of families with children, 60.8% (59.6–61.9) for adolescents, and 57.4% (56.9–57.8) for adults. For not leaving the house except for essential matters the proportions were 81.7% (80.5–82.9), 70.6% (69.6–61.9), and 65.1% (64.7–65.5), respectively. Among children and adolescents, social distancing was strongly associated with socioeconomic status, being much higher in the better-off families. CONCLUSIONS The prevalence of antibodies against SARS-CoV-2 showed comparable levels among children, adolescents, and adults. Adherence to social distancing measures was more prevalent in children, followed by adolescents. There were important socioeconomic differences in the adherence to social distancing among children and adolescents

Countdown to 2030 : tracking progress towards universal coverage for reproductive, maternal, newborn, and child health

Building upon the successes of Countdown to 2015, Countdown to 2030 aims to support the monitoring and measurement of women's, children's, and adolescents' health in the 81 countries that account for 95% of maternal and 90% of all child deaths worldwide. To achieve the Sustainable Development Goals by 2030, the rate of decline in prevalence of maternal and child mortality, stillbirths, and stunting among children younger than 5 years of age needs to accelerate considerably compared with progress since 2000. Such accelerations are only possible with a rapid scale-up of effective interventions to all population groups within countries (particularly in countries with the highest mortality and in those affected by conflict), supported by improvements in underlying socioeconomic conditions, including women's empowerment. Three main conclusions emerge from our analysis of intervention coverage, equity, and drivers of reproductive, maternal, newborn, and child health (RMNCH) in the 81 Countdown countries. First, even though strong progress was made in the coverage of many essential RMNCH interventions during the past decade, many countries are still a long way from universal coverage for most essential interventions. Furthermore, a growing body of evidence suggests that available services in many countries are of poor quality, limiting the potential effect on RMNCH outcomes. Second, within-country inequalities in intervention coverage are reducing in most countries (and are now almost non-existent in a few countries), but the pace is too slow. Third, health-sector (eg, weak country health systems) and non-health-sector drivers (eg, conflict settings) are major impediments to delivering high-quality services to all populations. Although more data for RMNCH interventions are available now, major data gaps still preclude the use of evidence to drive decision making and accountability. Countdown to 2030 is investing in improvements in measurement in several areas, such as quality of care and effective coverage, nutrition programmes, adolescent health, early childhood development, and evidence for conflict settings, and is prioritising its regional networks to enhance local analytic capacity and evidence for RMNCH

Socioeconomic inequalities in reproductive, maternal, newborn and child health in Guyana: a time trends analysis

# Background Guyana is among the countries committed to achieving the sustainable development goals. This research assessed the patterns of change in reproductive, maternal, newborn, and child health (RMNCH) in Guyana. # Methods Four nationally representative surveys conducted from 2009 to 2019 were assessed. Temporal trends in RMNCH indicators were assessed at the national level, by place of residence, and by wealth index. The slope index and concentration index of inequality were calculated to assess trends in inequalities over time. The average absolute annual change (AAAC) of the indicators was calculated using a weighted variance regression. # Results From 2006 to 2019, we observed an increase in the coverage of institutional delivery (from 82.6% to 97.7%), and exclusive breastfeeding (from 21.4% to 31.0%), among others. Likewise, antenatal care with four or more visits increased from 77.4% in 2009 to 84.7% in 2019. The opposite was observed for coverage of current contraceptive use (modern methods) (from 32.7% to 28.2%), family planning needed satisfied (from 49.6% to 43.8%), tetanus toxoid in pregnancy (from 31.7% to 8.2%) and full vaccination coverage (from 82.0% to 63.4%). Under-five stunting prevalence decreased from 18.0% to 9.2% and the under-five mortality rate from 40.4 to 29.3 per 1,000 live births. The gap between the poorest and richest women tended to decrease for seven out of the 16 intervention indicators, as well as for under-five stunting prevalence and under-five mortality rate. Institutional delivery was the best performer in increasing coverage and decreasing inequality over time, while immunization with measles was the worst performer. # Conclusions Guyana has made great progress in improving its RMNCH indicators. However, the observed decline in the coverage of several RMNCH indicators can be seen as a warning sign to redouble efforts to achieve sustainable development goals, SDGs 1 and 2, by 2030 and to reduce inequalities by lagging no one behind

Association between ethnicity and under-5 mortality: analysis of data from demographic surveys from 36 low-income and middle-income countries

Background The UN Sustainable Development Goals (SDGs) call for stratification of social indicators by ethnic groups; however, no recent multicountry analyses on ethnicity and child survival have been done in low-income and middle-income countries (LMICs). Methods We used data from Demographic and Health Surveys and Multiple Indicator Cluster Surveys collected between 2010 and 2016, from LMICs that provided birth histories and information on ethnicity or a proxy variable. We calculated neonatal (age 0–27 days), post-neonatal (age 28–364 days), child (age 1–4 years), and under-5 mortality rates (U5MRs) for each ethnic group within each country. We assessed differences in mortality between ethnic groups using a likelihood ratio test, Theil’s index, and between-group variance. We used multivariable analyses of U5MR by ethnicity to adjust for household wealth, maternal education, and urban–rural residence. Findings We included data from 36 LMICs, which included 2 812 381 livebirths among 415 ethnic groups. In 25 countries, significant differences in U5MR by ethnic group were identified (all p<0·05 likelihood ratio test). In these countries, the median mortality ratio between the ethnic groups with the highest and lowest U5MRs was 3·3 (IQR 2·1–5·2; range 1·5–8·5), whereas among the remaining 11 countries, the median U5MR ratio was 1·9 (IQR 1·7–2·5; range 1·4–10·0). Ethnic gaps were wider for child mortality than for neonatal or post-neonatal mortality. In nearly all countries, adjustment for wealth, education, and place of residence did not affect ethnic gaps in mortality, with the exception of Guatemala, India, Laos, and Nigeria. The largest ethnic group did not have the lowest U5MR in any of the countries studied. Interpretation Significant ethnic disparities in child survival were identified in more than two-thirds of the countries studied. Regular analyses of ethnic disparities are essential for monitoring trends, targeting, and assessing the impact of health interventions. Such analyses will contribute to the effort towards leaving no one behind, which is at the centre of the SDGs

Mensuração de desigualdades sociais em saúde: conceitos e abordagens metodológicas no contexto brasileiro

Resumo O objetivo deste artigo é apresentar os principais métodos de mensuração e monitoramento das desigualdades sociais em saúde e ilustrar suas aplicações. Foram revisadas as medidas mais frequentemente empregadas na literatura. Dados de cobertura e qualidade do cuidado pré-natal no Brasil, provenientes da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher (PNDS-2006) e da Pesquisa Nacional de Saúde (PNS-2013), foram utilizados para exemplificar as aplicações. Medidas de desigualdade absoluta e relativa foram apresentadas, destacando-se sua complementaridade. Apesar dos avanços evidenciados nos indicadores nacionais de pré-natal, importantes desigualdades foram identificadas entre subgrupos da população, sem que houvesse redução da magnitude dessas diferenças no período estudado. O Brasil apresenta importantes desigualdades sociais, que ainda se refletem em persistentes desigualdades em saúde. A descrição e monitoramento dessas desigualdades são fundamentais para o direcionamento de políticas de saúde, com foco em grupos mais vulneráveis que vêm sendo deixados para trás

Exploring the potential for a new measure of socioeconomic deprivation status to monitor health inequality

Background: Monitoring health inequalities is an important task for health research and policy, to uncover who is being left behind – and where – and to inform effective and equitable policies and programmes to tackle existing inequities. The choice of which measure to use to monitor and analyse health inequalities is thereby not trivial. This article explores a new measure of socioeconomic deprivation status (SDS) to monitor health inequalities. Methods: The SDS measure was constructed using the Alkire-Foster method. It includes eight indicators across two qually weighted dimensions (education and living standards) and specifies a four-level gradient of socioeconomic deprivation at the household-level. We conducted four exercises to examine the value-added of the proposed SDS, using Demographic and Health Surveys data. First, we examined the discriminatory power of the new measure when applied to outcomes in four select reproductive, maternal, neonatal, and child health (RMNCH) indicators across six countries: skilled birth attendance, stunting, U5MR, and DTP3 immunisation. Then, we analysed the behaviour and association of the new SDS vis-à-vis the DHS Wealth Index, including chi-squared test and Pearson correlation coefficient. Third, we analysed the robustness of SDS results to changes in its structure, using pairwise comparisons and Kendal Tau-b rank correlation. Finally, we illustrated some of the advantageous properties of the new measure, disaggregation and decomposition, on Haitian data. Results: 1) Higher levels of socioeconomic deprivation are generally consistently associated with lower levels of achievements in the RMNCH indicators across countries. 2) 87% of all pairwise rank comparisons across a range of SDS measure structures were robust. 3) SDS and DHS Wealth Index are associated, but with considerable cross-country variation, highlighting their complementarity. 4) Haitian households in rural areas experienced, on average, more severe socioeconomic deprivation as well as lower levels of RMNCH achievement than urban households. Conclusions: The proposed SDS adds analytical possibilities to the health inequality monitoring literature, in line with ethically and conceptually well-founded notions of absolute, multidimensional disadvantage. In addition, it allows for breakdown if its dimensions and components, which may facilitate nuanced analyses of health inequality, its correlates, and determinants

Population-level seropositivity trend for SARS-Cov-2 in Rio Grande do Sul, Brazil

OBJECTIVE: To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS: Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1–8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9–10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS: Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS: The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels.OBJECTIVE: To describe the evolution of seropositivity in the State of Rio Grande do Sul, Brazil, through 10 consecutive surveys conducted between April 2020 and April 2021. METHODS: Nine cities covering all regions of the State were studied, 500 households in each city. One resident in each household was randomly selected for testing. In survey rounds 1–8 we used the rapid WONDFO SARS-CoV-2 Antibody Test (Wondfo Biotech Co., Guangzhou, China). In rounds 9–10, we used a direct ELISA test that identifies IgG to the viral S protein (S-UFRJ). In terms of social distancing, individuals were asked three questions, from which we generated an exposure score using principal components analysis. RESULTS: Antibody prevalence in early April 2020 was 0.07%, increasing to 10.0% in February 2021, and to 18.2% in April 2021. In round 10, self-reported whites showed the lowest seroprevalence (17.3%), while indigenous individuals presented the highest (44.4%). Seropositivity increased by 40% when comparing the most with the least exposed. CONCLUSIONS: The proportion of the population already infected by SARS-Cov-2 in the state is still far from any perspective of herd immunity and the infection affects population groups in very different levels