You are here

Article Text

Article menu

Download PDFPDF

Original research
Spatial patterns and inequalities in skilled birth attendance and caesarean delivery in sub-Saharan Africa
  1. Firew Tekle Bobo1,2,
  2. Augustine Asante3,
  3. Mirkuzie Woldie4,5,
  4. Angela Dawson2,
  5. Andrew Hayen2
  1. 1Department of Public Health, Institute of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
  2. 2School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia
  3. 3School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
  4. 4Department of Health Policy and Management, Jimma University, Jimma, Oromia, Ethiopia
  5. 5Fenot Project, Harvard T.H. Chan School of Public Health, Addis Ababa, Ethiopia
  1. Correspondence to Firew Tekle Bobo; firew.t.bobo{at}student.uts.edu.au

Abstract

Background Improved access to and quality obstetric care in health facilities reduces maternal and neonatal morbidity and mortality. We examined spatial patterns, within-country wealth-related inequalities and predictors of inequality in skilled birth attendance and caesarean deliveries in sub-Saharan Africa.

Methods We analysed the most recent Demographic and Health Survey data from 25 sub-Saharan African countries. We used the concentration index to measure within-country wealth-related inequality in skilled birth attendance and caesarean section. We fitted a multilevel Poisson regression model to identify predictors of inequality in having skilled attendant at birth and caesarean section.

Results The rate of skilled birth attendance ranged from 24.3% in Chad to 96.7% in South Africa. The overall coverage of caesarean delivery was 5.4% (95% CI 5.2% to 5.6%), ranging from 1.4% in Chad to 24.2% in South Africa. The overall wealth-related absolute inequality in having a skilled attendant at birth was extremely high, with a difference of 46.2 percentage points between the poorest quintile (44.4%) and the richest quintile (90.6%). In 10 out of 25 countries, the caesarean section rate was less than 1% among the poorest quintile, but the rate was more than 15% among the richest quintile in nine countries. Four or more antenatal care contacts, improved maternal education, higher household wealth status and frequently listening to the radio increased the rates of having skilled attendant at birth and caesarean section. Women who reside in rural areas and those who have to travel long distances to access health facilities were less likely to have skilled attendant at birth or caesarean section.

Conclusions There were significant within-country wealth-related inequalities in having skilled attendant at birth and caesarean delivery. Efforts to improve access to birth at the facility should begin in areas with low coverage and directly consider the needs and experiences of vulnerable populations.

  • epidemiology
  • health economics
  • health policy
  • health systems
  • health services research

Data availability statement

Data are available in a public, open access repository. Data for this study were sourced from Demographic and Health surveys (DHS) and available here: http://dhsprogram.com/data/available-datasets.cfm.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjgh-2021-007074

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available in a public, open access repository. Data for this study were sourced from Demographic and Health surveys (DHS) and available here: http://dhsprogram.com/data/available-datasets.cfm.

    View Full Text

    Footnotes

    • Handling editor Seye Abimbola

    • Contributors FTB, AA, MW, AD and AH contributed to the study design and conceptualisation. FTB reviewed the literature, performed the analysis and drafted the first draft of this manuscript. AH helped revise the study design, supervised the data analysis. AA, MW, AD and AH provided technical support and critically reviewed the manuscript. FTB had final responsibility to submit for publication. All authors read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.