Wealth inequalities in reproductive and child health preventive care in Mozambique: a decomposition analysis

ABSTRACT

Background

Assessing the gap between rich and poor is important to monitor inequalities in health. Identifying the contribution to that gap can help policymakers to develop interventions towards decreasing that difference.

Objective

To quantify the wealth inequalities in health preventive measures (bed net use, vaccination, and contraceptive use) to determine the demographic and socioeconomic contribution factors to that inequality using a decomposition analysis.

Methods

Data from the 2015 Immunisation, Malaria and AIDs Indicators Survey were used. The total sample included 6946 women aged 15–49 years. Outcomes were use of insecticide-treated nets (ITN), child vaccination, and modern contraception use. Wealth Index was the exposure variable and age, marital status, place of residence, region, education, occupation, and household wealth index were the explanatory variables. Wealth inequalities were assessed using concentration indexes (Cindex). Wagstaff-decomposition analysis was conducted to assess the determinants of the wealth inequality.

Results

The Cindex was −0.081 for non-ITN, −0.189 for lack of vaccination coverage and −0.284 for non-contraceptive use, indicating a pro-poor inequality. The results revealed that 88.41% of wealth gap for ITN was explained by socioeconomic factors, with education and wealth playing the largest roles. Lack of full vaccination, socioeconomic factors made the largest contribution, through the wealth variable, whereas geographic factors came next. Finally, the lack of contraceptive use, socioeconomic factors were the main explanatory factors, but to a lesser degree than the other two outcomes, with wealth and education contributing most to explaining the gap.

Conclusion

There was a pro-poor inequality in reproductive and child preventive measures in Mozambique. The greater part of this inequality could be attributed to wealth, education, and residence in rural areas. Resources should be channeled into poor and non-educated rural communities to tackle these persistent inequities in preventive care.

KEYWORDS:

• Socioeconomic inequality
• decomposition analysis
• health preventive care
• Mozambique

Responsible Editor

Maria Nilsson

Responsible Editor

Maria Nilsson

Authors contributions

CD, Drafted the manuscript, analysis and interpretation of data, MSS made a substantial contribution, revising it for scientific content, BS, made a substantial contribution, revising it for scientific content, CA, made a substantial contribution,revising it for scientific content. All authors approved the final version.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

The study used purely IMASIDA secondary data from Demographic and Health Survey which is a publicly available data at the DHS website upon request. Thus, the usage of the data is covered by the ethics approval secured by DHS for the collection of the data.

Paper context

Socioeconomic factors, particularly poverty, are associated with the use of health care services in Mozambique. Less is known about the determinants explaining socioeconomic differences. This paper presents wealth inequalities in insecticide treated bed-nets, child vaccination and modern contraceptive use disfavouring the poor, and reveals wealth, education, and rurality as key determinants of those inequalities. Results suggest the need to channel resources to the non-educated, poor rural communities to reduce wealth inequalities in preventive health care measures.

Additional information

Funding

This research was supported by the Swedish International Development Agency (SIDA).