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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Pregnancy and Childbirth 1/2018

Absolute income is a better predictor of coverage by skilled birth attendance than relative wealth quintiles in a multicountry analysis: comparison of 100 low- and middle-income countries

Zeitschrift:
BMC Pregnancy and Childbirth > Ausgabe 1/2018
Autoren:
Gary Joseph, Inácio C. M. da Silva, Günther Fink, Aluisio J. D. Barros, Cesar G. Victora
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12884-018-1734-0) contains supplementary material, which is available to authorized users.

Abstract

Background

Having high-quality data available by 2020, disaggregated by income, is one of the Sustainable Development Goals (SGD). We explored how well coverage with skilled birth attendance (SBA) is predicted by asset-based wealth quintiles and by absolute income.

Methods

We used data from 293 national surveys conducted in 100 low and middle-income countries (LMICs) from 1991 to 2014. Data on household income were computed using national income levels and income inequality data available from the World Bank and the Standardized World Income Inequality Database. Multivariate regression was used to explore the predictive capacity of absolute income compared to the traditional measure of quintiles of wealth index.

Results

The mean SBA coverage was 68.9% (SD: 24.2), compared to 64.7% (SD: 26.6) for institutional delivery coverage. Median daily family income in the same period was US$ 6.4 (IQR: 3.5–14.0). In cross-country analyses, log absolute income predicts 51.5% of the variability in SBA coverage compared to 22.0% predicted by the wealth index. For within-country analysis, use of absolute income improved the understanding of the gap in SBA coverage among the richest and poorest families. Information on income allowed identification of countries – such as Burkina Faso, Cambodia, Egypt, Nepal and Rwanda – which were well above what would be expected solely from changes in income.

Conclusion

Absolute income is a better predictor of SBA and institutional delivery coverage than the relative measure of quintiles of wealth index and may help identify countries where increased coverage is likely due to interventions other than increased income.
Zusatzmaterial
Additional file 2: Table S2. Linear regression analyses to investigate how well relative quintiles, actual mean wealth index scores and absolute income (per quintile) predict institutional delivery coverage (N = 1460 observations). Description: Robust standard errors in parentheses are clustered at the country level. * Income is expressed in 2011 purchasing power parity-adjusted international dollars. Model 1 and model 4: cross-country and within-country prediction of institutional delivery coverage according to wealth quintiles. Model 2 and model 5: cross-country and within-country prediction of institutional delivery coverage according to actual mean wealth scores. Model 3 and model 6: cross-country and within-country prediction of institutional delivery coverage according to household income. Model 7: within-country prediction of institutional delivery coverage according to wealth quintiles and household income. Figure S1. Institutional delivery coverage by log absolute income. Each dot is one quintile in each survey. Figure S2. Institutional delivery coverage in Namibia, Nigeria and Ethiopia according to a) wealth quintiles and b) absolute income in the most recent survey. Figure S3. Five countries with increases in institutional delivery coverage > = 40 percentage points over time: Cambodia, Egypt, Indonesia, Nepal and Rwanda. Figure S4. Four countries with increases in institutional delivery coverage < 10 percentage points over 10 or more years: Central African Republic (CAR), Ethiopia, Madagascar and Tanzania. Figure S5. Two countries with no progress in household income over 10 or more years but with increase in institutional delivery coverage (Bolivia, Haiti). (PDF 812 kb)
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