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      Equity in newborn care, evidence from national surveys in low- and middle-income countries

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          Abstract

          Background

          High coverage of care is essential to improving newborn survival; however, gaps exist in access to timely and appropriate newborn care between and within countries. In high mortality burden settings, health inequities due to social and economic factors may also impact on newborn outcomes. This study aimed to examine equity in co-coverage of newborn care interventions in low- and low middle-income countries in sub-Saharan Africa and South Asia.

          Methods

          We analysed secondary data from recent Demographic and Health Surveys in 16 countries. We created a co-coverage index of five newborn care interventions. We examined differences in coverage and co-coverage of newborn care interventions by country, place of birth, and wealth quintile. Using multilevel logistic regression, we examined the association between high co-coverage of newborn care (4 or 5 interventions) and social determinants of health.

          Results

          Coverage and co-coverage of newborn care showed large between- and within-country gaps for home and facility births, with important inequities based on individual, family, contextual, and structural factors. Wealth-based inequities were smaller amongst facility births compared to non-facility births.

          Conclusion

          This analysis underlines the importance of facility birth for improved and more equitable newborn care. Shifting births to facilities, improving facility-based care, and community-based or pro-poor interventions are important to mitigate wealth-based inequities in newborn care, particularly in countries with large differences between the poorest and richest families and in countries with very low coverage of care.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12939-021-01452-z.

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          Most cited references47

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          Applying an equity lens to interventions: using PROGRESS ensures consideration of socially stratifying factors to illuminate inequities in health.

          To assess the utility of an acronym, place of residence, race/ethnicity/culture/language, occupation, gender/sex, religion, education, socioeconomic status, and social capital ("PROGRESS"), in identifying factors that stratify health opportunities and outcomes. We explored the value of PROGRESS as an equity lens to assess effects of interventions on health equity.
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            Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?

            Progress in newborn survival has been slow, and even more so for reductions in stillbirths. To meet Every Newborn targets of ten or fewer neonatal deaths and ten or fewer stillbirths per 1000 births in every country by 2035 will necessitate accelerated scale-up of the most effective care targeting major causes of newborn deaths. We have systematically reviewed interventions across the continuum of care and various delivery platforms, and then modelled the effect and cost of scale-up in the 75 high-burden Countdown countries. Closure of the quality gap through the provision of effective care for all women and newborn babies delivering in facilities could prevent an estimated 113,000 maternal deaths, 531,000 stillbirths, and 1·325 million neonatal deaths annually by 2020 at an estimated running cost of US$4·5 billion per year (US$0·9 per person). Increased coverage and quality of preconception, antenatal, intrapartum, and postnatal interventions by 2025 could avert 71% of neonatal deaths (1·9 million [range 1·6-2·1 million]), 33% of stillbirths (0·82 million [0·60-0·93 million]), and 54% of maternal deaths (0·16 million [0·14-0·17 million]) per year. These reductions can be achieved at an annual incremental running cost of US$5·65 billion (US$1·15 per person), which amounts to US$1928 for each life saved, including stillbirths, neonatal, and maternal deaths. Most (82%) of this effect is attributable to facility-based care which, although more expensive than community-based strategies, improves the likelihood of survival. Most of the running costs are also for facility-based care (US$3·66 billion or 64%), even without the cost of new hospitals and country-specific capital inputs being factored in. The maximum effect on neonatal deaths is through interventions delivered during labour and birth, including for obstetric complications (41%), followed by care of small and ill newborn babies (30%). To meet the unmet need for family planning with modern contraceptives would be synergistic, and would contribute to around a halving of births and therefore deaths. Our analysis also indicates that available interventions can reduce the three most common cause of neonatal mortality--preterm, intrapartum, and infection-related deaths--by 58%, 79%, and 84%, respectively. Copyright © 2014 Elsevier Ltd. All rights reserved.
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              Quality of care for pregnant women and newborns-the WHO vision.

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                Author and article information

                Contributors
                Kimberly.peven@kcl.ac.uk
                Journal
                Int J Equity Health
                Int J Equity Health
                International Journal for Equity in Health
                BioMed Central (London )
                1475-9276
                5 June 2021
                5 June 2021
                2021
                : 20
                : 132
                Affiliations
                [1 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, , King’s College London, ; London, UK
                [2 ]GRID grid.8991.9, ISNI 0000 0004 0425 469X, Maternal and Newborn Health Group, London School of Hygiene & Tropical Medicine, ; London, UK
                [3 ]GRID grid.164295.d, ISNI 0000 0001 0941 7177, University of Maryland, ; College Park, MD USA
                [4 ]GRID grid.475068.8, Avenir Health, ; Glastonbury, CT USA
                [5 ]GRID grid.5475.3, ISNI 0000 0004 0407 4824, School of Health Sciences, , University of Surrey, ; Guildford, UK
                [6 ]GRID grid.7372.1, ISNI 0000 0000 8809 1613, Warwick Clinical Trials Unit, , University of Warwick, ; Coventry, UK
                [7 ]Ministry of Health, Yaoundé, Cameroon
                [8 ]GRID grid.4464.2, ISNI 0000 0001 2161 2573, School of Health Sciences, City, , University of London, ; London, UK
                Author information
                http://orcid.org/0000-0002-0047-4084
                Article
                1452
                10.1186/s12939-021-01452-z
                8178885
                34090427
                0bc4a407-9813-472f-8865-2bb15a64bc9d
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 3 February 2021
                : 19 April 2021
                Funding
                Funded by: King's College London Centre for Doctoral Studies
                Categories
                Research
                Custom metadata
                © The Author(s) 2021

                Health & Social care
                infant,newborn,health equity,socioeconomic factors,postnatal care
                Health & Social care
                infant, newborn, health equity, socioeconomic factors, postnatal care

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