# 02 May 2014 Assessing inequality in reproductive, maternal and child health in Lao PDR.

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02 May 2014 Assessing inequality in reproductive, maternal and child health in Lao PDR

Indicators Antenatal care (at least one visit) Careseeking for pneumonia DPT3 immunization Early initiation of breastfeeding Measles immunization Oral rehydration therapy for children with diarrhoea Births attended by skilled health personnel Stunting (height for age) in children under 5 years Underweight (weight for age) in children under 5 years Wasting (weight for height) in children under 5 years

Dimensions of inequality Wealth Education Sex Area.

Each indicator, three aspects will be assessed 1. The latest status (from MICS 2011) 2. The time trend (2006 to 2011) 3. Benchmarking against other countries in the Asia Pacific Region

Example for HD*calc analysis of latest status Indicator Education 2011 AbsoluteRelative Antenatal care (at least one visit) 49.5223.140 Careseeking for pneumonia 34.7861.860 DPT3 immunization 38.6802.160 Early initiation of breastfeeding 14.9311.479 Measles immunization 30.2911.674 Oral rehydration therapy for children with diarrhoea 17.2091.329 Births attended by skilled health personnel 47.7863.973 Stunting (height for age) in children under 5 years 23.8951.703 Underweight (weight for age) in children under 5 years 14.6531.722 Wasting (weight for height) in children under 5 years 0.8941.154 - Slop index inequality(SII) and Relative concentration index(RCI)were selected for wealth stratifier - Range different(RD) and relative different(RR) were sected for education, sex and area. Absolute : If the value 0-20=1 Absolute : If the value 21-40=2 Absolute : If the value41-100=3 Relative: If the RR value 0-1.16=1 Relative: If the RR value 1.17-1.75=2 Relative: If the RR value 1.76-20=3

The latest status of inequality In 2011, indicators showed less than 60% in coverage and only 3 of the 10 indicators showed higher than 50%(ANC1,DPTV and Carep). Births attended by skilled health personnel showed greatest level of inequality across the 4 stratifiers (wealth-based, education based, sex based and area-based), And ANC1 is also showed high level of inequality as second

Indicator National average Inequality WealthEducationSexArea 2015 AbsoluteRelativeAbsoluteRelativeAbsoluteRelativeAbsoluteRelative 2011 avg Antenatal care (at least one visit) 13133na 235554 Careseeking for pneumonia 231231122 DPT3 immunization 131231112 Early initiation of breastfeeding 12112na 22 Measles immunization 3212211129063 Oral rehydration therapy for children with diarrhoea 111221112 Births attended by skilled health personnel 33133na 3350%42 RMCH interventions 21231122 Stunting (height for age) in children under 5 years 2312211233444 Underweight (weight for age) in children under 5 years 2211211132227 Wasting (weight for height) in children under 5 years 111111211 6 CH outcomes 21121112 3 (red) indicated urgent need for action, 2 (yellow) indicated that action is needed 1 (green) indicated that no action is needed. The most inequitable health services indicator across all equity stratifiers assessed was the presence of a skilled birth attendant Prioritizing the latest status of inequality and national coverage

Prioritizing the latest status of inequality and national coverage Urgent need for action. Births attended by skilled health personnel Measles immunization Need for action. Antenatal care (at least one visit) Stunting (height for age) in children under 5 years Underweight (weight for age) in children under 5 years

Most of indicators the trend of the inequality by stratifiers were no change or slight change and don’t show large gap of inequality over 5 years. ANC, DPTV and SBA showed highest inequality of absolute number. The largest increase in coverage was seen in measles immunization by 20% from 2006 to2011. Care seeking for pneumonia and early initiation of breastfeeding show second and third respectively and the rest indicators were slightly changed. Trend of Inequality by Stratifiers

Example table for trend analyzed by HD*calc For wealth-based Indicator Inequality Wealth 20062011AbsoluteRelative Absolute(SII)Relative(RCI)Absolute(SII)Relative(RCI) Antenatal care (at least one visit) 73.6560.33088.3730.25914.717-0.071 Careseeking for pneumonia 36.2840.17447.4710.13411.187-0.040 DPT3 immunization 37.7330.14455.3540.15917.6210.015 Early initiation of breastfeeding 31.8880.16822.4920.092-9.396-0.076 Measles immunization 29.9120.11839.8460.1009.934-0.018 ORT 9.1650.02815.7750.0416.6100.013 Births attended by skilled health personnel 73.1440.56898.1880.37625.044-0.192 Stunting (height for age) in children under 5 years -35.410-0.118-49.961-0.179-14.551-0.061 Underweight (weight for age) in children under 5 years -23.975-0.120-29.543-0.176-5.568-0.056 Wasting (weight for height) in children under 5 years 0.5420.012-1.782-0.048-2.324-0.060

Prioritizing the time trend of inequality and national coverage Indicator National average Inequality WealthEducationSexAreaAverage inequality score AbsoluteRelativeAbsoluteRelativeAbsoluteRelativeAbsoluteRelativeAbsoluteRelative Antenatal care (at least one visit) 23111na 111.71.0 Careseeking for pneumonia 2211111211.51.0 DPT3 immunization 2322211111.81.5 Early initiation of breastfeeding 21111na 211.31.0 Measles immunization 1212121111.81.0 Oral rehydration therapy for children with diarrhoea 2222111111.51.3 Births attended by skilled health personnel 13111na 111.71.0 RMCH interventions 21111111 Stunting (height for age) in children under 5 years 2112122221.81.5 Underweight (weight for age) in children under 5 years 2111111121.01.3 Wasting (weight for height) in children under 5 years 2112222221.8 CH outcomes 11212222 3 (red) indicated urgent need for action, 2 (yellow) indicated that action is needed 1 (green) indicated that no action is needed.

Examples on trend of inequity in health (1)

Prioritizing the trend of inequality and national coverage Need for action: Antenatal care (at least one visit) Careseeking for pneumonia DPT3 immunization Early initiation of breastfeeding Oral rehydration therapy for children with diarrhoea Stunting (height for age) in children under 5 years Underweight (weight for age) in children under 5 years Wasting (weight for height) in children under 5 years

Benchmarking The red dot indicate the value of Lao PDR

Example: Oral rehydration therapy for children with diarrhea

Benchmarking Indicator National average Inequality Wealth AbsoluteRelative Antenatal care (at least one visit) 333 Careseeking for pneumonia 333 DPT3 immunization 333 Early initiation of breastfeeding 333 Measles immunization 333 Oral rehydration therapy for children with diarrhoea 122 Births attended by skilled health personnel 333 RMCH interventions 33 Stunting (height for age) in children under 5 years 333 Underweight (weight for age) in children under 5 years 222 Wasting (weight for height) in children under 5 years 121 CH outcomes 22 3 (red) indicated urgent need for action, 2 (yellow) indicated that action is needed 1 (green) indicated that no action is needed.

conclusion Births attended by skilled health personnel and Antenatal care (at least one visit) showed greatest level of inequality across the 4 stratifiers Most of the indicator when compared to other countries in the Asia Pacific Region, Laos had the highest absolute wealth-based inequality in our assess inequitable health services indicator across all equity stratifiers with low coverage 8 0f 10 indicators.

Conclusion Urgent action should be taken for these indicators below: Antenatal care ( at least one visit) Births attended by skilled health personnel Careseeking for pneumonia DPT3 immunization Early initiation of breastfeeding Stunting (height for age) in children under 5 years Underweight (weight for age) in children under 5 years

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