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Measuring Coverage in MNCH: Determining and Interpreting Inequalities in Coverage of Maternal, Newborn, and Child Health Interventions

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  • Aluísio J D Barros
  • Cesar G Victora

Abstract

In a PLOS Medicine Review, Aluísio Barros and Cesar Victora provide a practical guide to measuring and interpreting inequalities in the coverage of maternal, newborn, and child interventions in low- and middle-income countries using data collected by large household surveys.To monitor progress towards the Millennium Development Goals, it is essential to monitor the coverage of health interventions in subgroups of the population, because national averages can hide important inequalities. In this review, we provide a practical guide to measuring and interpreting inequalities based on surveys carried out in low- and middle-income countries, with a focus on the health of mothers and children. Relevant stratification variables include urban/rural residence, geographic region, and educational level, but breakdowns by wealth status are increasingly popular. For the latter, a classification based on an asset index is the most appropriate for national surveys. The measurement of intervention coverage can be made by single indicators, but the use of combined measures has important advantages, and we advocate two summary measures (the composite coverage index and the co-coverage indicator) for the study of time trends and for cross-country comparisons. We highlight the need for inequality measures that take the whole socioeconomic distribution into account, such as the relative concentration index and the slope index of inequality, although simpler measures such as the ratio and difference between the richest and poorest groups may also be presented for non-technical audiences. Finally, we present a framework for the analysis of time trends in inequalities, arguing that it is essential to study both absolute and relative indicators, and we provide guidance to the joint interpretation of these results.

Suggested Citation

  • Aluísio J D Barros & Cesar G Victora, 2013. "Measuring Coverage in MNCH: Determining and Interpreting Inequalities in Coverage of Maternal, Newborn, and Child Health Interventions," PLOS Medicine, Public Library of Science, vol. 10(5), pages 1-9, May.
  • Handle: RePEc:plo:pmed00:1001390
    DOI: 10.1371/journal.pmed.1001390
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    Citations

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    Cited by:

    1. Arabinda Ghosh & Daniel J. Corsi & S. V. Subramanian, 2016. "A Tale of Two Bengals: A Comparative Analysis of 23 Indicators of Maternal, Newborn and Child Health," Journal of Development Policy and Practice, , vol. 1(1), pages 1-17, January.
    2. Lenka Benova & Oona M R Campbell & George B Ploubidis, 2014. "Socio-Economic Gradients in Maternal and Child Health-Seeking Behaviours in Egypt: Systematic Literature Review and Evidence Synthesis," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-12, March.
    3. Kim, Rockli & Rajpal, Sunil & Joe, William & Corsi, Daniel J. & Sankar, Rajan & Kumar, Alok & Subramanian, S.V., 2019. "Assessing associational strength of 23 correlates of child anthropometric failure: An econometric analysis of the 2015-2016 National Family Health Survey, India," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    4. Sander K R van Zon & Ute Bültmann & Carlos F Mendes de Leon & Sijmen A Reijneveld, 2015. "Absolute and Relative Socioeconomic Health Inequalities across Age Groups," PLOS ONE, Public Library of Science, vol. 10(12), pages 1-14, December.
    5. Cherri Zhang & Md Shafiur Rahman & Md Mizanur Rahman & Alfred E Yawson & Kenji Shibuya, 2019. "Trends and projections of universal health coverage indicators in Ghana, 1995-2030: A national and subnational study," PLOS ONE, Public Library of Science, vol. 14(5), pages 1-19, May.
    6. Abel Mukengeshayi Ntambue & Françoise Kaj Malonga & Michèle Dramaix-Wilmet & Tabitha Mpoyi Ilunga & Angel Nkola Musau & Charles Matungulu Matungulu & Karen D Cowgill & Philippe Donnen, 2018. "Commercialization of obstetric and neonatal care in the Democratic Republic of the Congo: A study of the variability in user fees in Lubumbashi, 2014," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-26, October.
    7. Parmar, Divya & Banerjee, Aneesh, 2019. "How do supply- and demand-side interventions influence equity in healthcare utilisation? Evidence from maternal healthcare in Senegal," Social Science & Medicine, Elsevier, vol. 241(C).
    8. Kimberly M Koporc & David R Hotchkiss & Charles F Stoecker & Deborah A McFarland & Thomas Carton, 2021. "Assessing the effects of disease-specific programs on health systems: An analysis of the Bangladesh Lymphatic Filariasis Elimination Program’s impacts on health service coverage and catastrophic healt," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 15(11), pages 1-21, November.
    9. Luis Huicho & Carlos A Huayanay-Espinoza & Patricia Hernandez & Jessica Niño de Guzman & Maria Rivera-Ch, 2018. "Enabling reproductive, maternal, neonatal and child health interventions: Time trends and driving factors of health expenditure in the successful story of Peru," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-16, October.
    10. Kerry L M Wong & María Clara Restrepo-Méndez & Aluísio J D Barros & Cesar G Victora, 2017. "Socioeconomic inequalities in skilled birth attendance and child stunting in selected low and middle income countries: Wealth quintiles or deciles?," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-17, May.
    11. Sanghita Bhattacharyya & Anns Issac & Bhushan Girase & Mayukhmala Guha & Joanna Schellenberg & Bilal Iqbal Avan, 2020. "“There Is No Link Between Resource Allocation and Use of Local Data”: A Qualitative Study of District-Based Health Decision-Making in West Bengal, India," IJERPH, MDPI, vol. 17(21), pages 1-14, November.

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