The contribution of poor and rural populations to nationaludtrends in reproductive, maternal, newborn, and child health coverage: analyses of cross-sectional surveys fromud64 countries

摘要

Background Coverage levels for essential interventions aimed at reducing deaths of mothers and children areudincreasing steadily in most low-income and middle-income countries. We assessed how much poor and ruraludpopulations in these countries are benefiting from national-level progress.udMethods We analysed trends in a composite coverage indicator (CCI) based on eight reproductive, maternal,udnewborn, and child health interventions in 209 national surveys in 64 countries, from Jan 1, 1994, to Dec 31, 2014.udTrends by wealth quintile and urban or rural residence were fitted with multilevel modelling. We used an approachudakin to the calculation of population attributable risk to quantify the contribution of poor and rural populations toudnational trends.udFindings From 1994 to 2014, the CCI increased by 0·82 percent points a year across all countries; households in theudtwo poorest quintiles had an increase of 0·99 percent points a year, which was faster than that for the three wealthiestudquintiles (0·68 percent points). Gains among poor populations were faster in lower-middle-income and uppermiddle-udincome countries than in low-income countries. Globally, national level increases in CCI were 17·5% fasterudthan they would have been without the contribution of the two poorest quintiles. Coverage increased more rapidlyudannually in rural (0·93 percent points) than urban (0·52 percent points) areas.udInterpretation National coverage gains were accelerated by important increases among poor and rural mothers andudchildren. Despite progress, important inequalities persist, and need to be addressed to achieve the SustainableudDevelopment Goals.