ABSTRACT
BACKGROUND: Though institutional delivery plays a significant role in maternal and child health, there is substantial evidence that the majority of rural women have lower health facility delivery than urban women. So, identifying the drivers of these disparities will help policy-makers and programmers with the reduction of maternal and child death. METHODS: The study used the data on a nationwide representative sample from the most recent rounds of the Demographic and Health Survey (DHS) of four East African countries. A Blinder-Oaxaca decomposition analysis and its extensions was conducted to see the urban-rural differences in institutional delivery into two components: one that is explained by residence difference in the level of the determinants (covariate effects), and the other components was explained by differences in the effect of the covariates on the outcome (coefficient effects). RESULTS: The findings showed that institutional delivery rates were 21.00% in Ethiopia, 62.61% in Kenya, 65.29% in Tanzania and 74.64% in Uganda. The urban-rural difference in institutional delivery was higher in the case of Ethiopia (61%), Kenya (32%) and Tanzania (30.3%), while the gap was relatively lower in the case of Uganda (19.2%). Findings of the Blinder-Oaxaca decomposition and its extension showed that the covariate effect was dominant in all study countries. The results were robust to the different decomposition weighting schemes. The frequency of antenatal care, wealth and parity inequality between urban and rural households explains most of the institutional delivery gap. CONCLUSIONS: The urban-rural institutional delivery disparities were high in study countries. By identifying the underlying factors behind the urban-rural institutional birth disparities, the findings of this study help in designing effective intervention measures targeted at reducing residential inequalities and improving population health outcomes. Future interventions to encourage institutional deliveries to rural women of these countries should therefore emphasize increasing rural women's income, access to health care facilities to increase the frequency of antenatal care utilization.
Subject(s)
Delivery of Health Care , Health Status Disparities , Labor, Obstetric , Maternal Health Services , Rural Population , Urban Population , Adolescent , Adult , Africa, Eastern , Female , Humans , Middle Aged , PregnancyABSTRACT
BACKGROUND: Both household food insecurity and household dietary diversity have been found reliable in describing the dietary intake of a population. However, it had not been proven as reliable instrument for assessing nutritional status of individuals in a clinical context. There has been a need for evidence on the validity of using proxy and easy dietary indicators for nutritional status. METHOD: A facility based cross sectional study design was employed on 423 people with HIV infection visiting all ART clinics in Bahir Dar, North Ethiopia. Nutritional status was determined by computing BMI. Food insecurity was assessed using household food insecurity access scale. Dietary diversity was measured using a tool adopted from Food and Nutrition Technical Assistance Project. Data were entered to Epidata version 3.1and analyzed by SPSS version 20. Reliability analysis, sensitivity and specificity analysis were determined. RESULT: The sensitivity of the household food insecurity access scale and dietary diversity score was 87.9% and 79.8%, respectively, while their specificity was 56.2% and 70.2%. The AUC at 95% CI for the household food insecurity access scale and household dietary diversity score were 73.4 (68.4-78.4) and 73.1 (68.1-78.2) while their cut of point that maximized their sensitivity and specificity was 1 and 6 respectively. Household food insecurity access scale and household dietary diversity score were found to be reliable tools with a Cronbach's Alpha of 0.926 and 0.799, respectively. CONCLUSION: In assessing under nutrition among PLHIV especially in limited resource settings, both the household food insecurity access scale and household dietary diversity score were found valid and reliable proxy indicators for measuring nutritional status.
