advanced search

<< Back To Home

MEASURING COVERAGE IN MNCH: DETERMINING AND INTERPRETING INEQUALITIES IN COVERAGE OF MATERNAL, NEWBORN, AND CHILD HEALTH INTERVENTIONS

Wednesday, 12th of June 2013

• MEASURING COVERAGE IN MNCH: DETERMINING AND INTERPRETING INEQUALITIES IN COVERAGE OF MATERNAL, NEWBORN, AND CHILD HEALTH INTERVENTIONS

Full text, with graphics, is at

http://www.ploscollections.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001390

Abstract

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.

Citation: Barros AJD, Victora CG (2013) Measuring Coverage in MNCH: Determining and Interpreting Inequalities in Coverage of Maternal, Newborn, and Child Health Interventions. PLoS Med 10(5): e1001390. doi:10.1371/journal.pmed.1001390

Academic Editor: Nyovani Madise, Professor of Demography and Social Statistics, University of Southampton, United Kingdom

Published: May 7, 2013

Copyright: © 2013 Barros, Victora. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding: This work was conducted under the auspices of the Child Health Epidemiology Reference Group (CHERG) for WHO and UNICEF, with financial support from The Bill & Melinda Gates Foundation through their grant to the US Fund for UNICEF. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Competing interests: The authors have declared that no competing interests exist.

Abbreviations: CCI, composite coverage index; CIX, concentration index; DHS, Demographic and Health Survey/s; MICS, Multiple Indicator Cluster Survey/s; MNCH, maternal, newborn, and child health; RII, relative index of inequality; SII, slope index of inequality

Provenance: Submitted as part of a sponsored Collection; externally reviewed.

This paper is part of the PLOS Medicine “Measuring Coverage in MNCH" Collection