A mediation approach to understanding socio-economic inequalities in maternal health-seeking behaviours in Egypt

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• 作者：Lenka Benova (1)
  Oona MR Campbell (1)
  George B Ploubidis (1) (2)
  
  1. Faculty of Epidemiology and Population Health ; London School of Hygiene and Tropical Medicine ; Keppel Street ; London ; WC1E 7HT ; UK
  2. Centre for Longitudinal Studies ; Institute of Education ; London ; WC1H 0AL ; UK
  
• 关键词：Maternal health ; Egypt ; Socio ; economic inequalities ; Antenatal care ; Facility delivery ; Mediation analysis ; Health ; seeking behaviour ; Care utilisation
• 刊名：BMC Health Services Research
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：15
• 期：1
• 全文大小：936 KB
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• 刊物主题：Public Health; Health Administration; Health Informatics; Nursing Management/Nursing Research;
• 出版者：BioMed Central
• ISSN：1472-6963

文摘

Background The levels and origins of socio-economic inequalities in health-seeking behaviours in Egypt are poorly understood. This paper assesses the levels of health-seeking behaviours related to maternal care (antenatal care [ANC] and facility delivery) and their accumulation during pregnancy and childbirth. Secondly, it explores the mechanisms underlying the association between socio-economic position (SEP) and maternal health-seeking behaviours. Thirdly, it examines the effectiveness of targeting of free public ANC and delivery care. Methods Data from the 2008 Demographic and Health Survey were used to capture two latent constructs of SEP: individual socio-cultural capital and household-level economic capital. These variables were entered into an adjusted mediation model, predicting twelve dimensions of maternal health-seeking; including any ANC, private ANC, first ANC visit in first trimester, regular ANC (four or more visits during pregnancy), facility delivery, and private delivery. ANC and delivery care costs were examined separately by provider type (public or private). Results While 74.2% of women with a birth in the 5-year recall period obtained any ANC and 72.4% delivered in a facility, only 48.8% obtained the complete maternal care package (timely and regular facility-based ANC as well as facility delivery) for their most recent live birth. Both socio-cultural capital and economic capital were independently positively associated with receiving any ANC and delivering in a facility. The strongest direct effect of socio-cultural capital was seen in models predicting private provider use of both ANC and delivery. Despite substantial proportions of women using public providers reporting receipt of free care (ANC: 38%, delivery: 24%), this free-of-charge public care was not effectively targeted to women with lowest economic resources. Conclusions Socio-cultural capital is the primary mechanism leading to inequalities in maternal health-seeking in Egypt. Future studies should therefore examine the objective and perceived quality of care from different types of providers. Improvements in the targeting of free public care could help reduce the existing SEP-based inequalities in maternal care coverage in the short term.