Wealth-related inequalities in the coverage of reproductive, maternal, newborn and child health interventions in 36 countries in the African Region.

OBJECTIVE: To investigate whether sub-Saharan African countries have succeeded in reducing wealth-related inequalities in the coverage of reproductive, maternal, newborn and child health interventions. METHODS: We analysed survey data from 36 countries, grouped into Central, East, Southern and West Africa subregions, in which at least two surveys had been conducted since 1995. We calculated the composite coverage index, a function of essential maternal and child health intervention parameters. We adopted the wealth index, divided into quintiles from poorest to wealthiest, to investigate wealth-related inequalities in coverage. We quantified trends with time by calculating average annual change in index using a least-squares weighted regression. We calculated population attributable risk to measure the contribution of wealth to the coverage index. FINDINGS: We noted large differences between the four regions, with a median composite coverage index ranging from 50.8% for West Africa to 75.3% for Southern Africa. Wealth-related inequalities were prevalent in all subregions, and were highest for West Africa and lowest for Southern Africa. Absolute income was not a predictor of coverage, as we observed a higher coverage in Southern (around 70%) compared with Central and West (around 40%) subregions for the same income. Wealth-related inequalities in coverage were reduced by the greatest amount in Southern Africa, and we found no evidence of inequality reduction in Central Africa. CONCLUSION: Our data show that most countries in sub-Saharan Africa have succeeded in reducing wealth-related inequalities in the coverage of essential health services, even in the presence of conflict, economic hardship or political instability.

Determinantes das diferenças de mortalidade infantil entre as etnias da Guiné-Bissau, 1990-1995 / Decisive of the differences of infantile mortality among the ethnics groups of Guiné-Bissau

A Guiné-Bissau fica situada na costa ocidental da Africa. Sua populaçao de pouco mais de um milhao de habitantes conta com cerca de trinta grupos étnicos, distribuídos em oito regioes administrativas. O país é um dos mais pobres do mundo e atravessa graves problemas de saúde. A mortalidade infantil, estimada em 1996, situa-se por volta dos 145/1.000 nascidos vivos. Descreve os determinantes das diferenças de mortalidade por etnias e regioes entre os fatores demográficos-maternos, fatores socioculturais e econômicos e fatores de uso dos serviços de saúde, de modo a permitir a adoçao de medidas e estratégias adequadas a cada etnia, as quais visam diminuir a mortalidade infantil. Maior destaque é dado aos fatores de uso dos serviços de saúde. De fato, o uso dos serviços de saúde -representado por consultas pré-natais, local de parto e cobertura vacinal de BCG e anti-sarampo- é o principal determinante das diferenciaçoes dos níveis de mortalidade infantil entre as principais etnias e regioes do país.