Publications Summary

Document Type
Analytical Studies
Publication Topic(s)
Child Health and Development, Health facilities/SPA surveys
Malawi, Senegal, Tanzania, Nepal, Haiti
Recommended Citation
Riese, Sara, Shireen Assaf, and Thomas W. Pullum. 2022. Equity in Effective Coverage of Antenatal and Sick Child Care. DHS Analytical Reports No. 84. Rockville, Maryland, USA: ICF.
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Publication Date
September 2022
Publication ID


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Countries are increasingly using measures of effective coverage to evaluate the performance of their health care system. Examining inequities in effective coverage can unmask hidden variations within effective coverage estimates. This study looks at inequities in antenatal care and sick child effective coverage by place of residence, wealth quintile, and region in five countries —Haiti, Malawi, Nepal, Senegal, and Tanzania— using previously developed measures that combine data from the Demographic and Health Surveys and the Service Provision Assessment. We first describe the components of the effective coverage cascade. We found that for antenatal care, disparities were most common in receipt of complete intervention (4+ antenatal care visits). This measure varied significantly by place of residence, wealth quintile, and region in all five countries. There was no consistent pattern to the disparities in measures of the components of sick child effective coverage. Senegal had the largest number of significant inequities in components of the antenatal care effective coverage cascade, while Haiti had the largest number of significant inequities in components of the sick child effective coverage cascade. Along the cascade, we see the largest absolute difference in intervention-adjusted coverage for antenatal care. For sick child care, no effective coverage estimate consistently had the largest absolute difference, and most differences were not statistically significant. Results show that there are greater and more frequent disparities in antenatal care quality-adjusted coverage when compared to the disparities in sick child quality-adjusted coverage. This study demonstrates that national-level estimates of antenatal and sick child effective coverage hide some significant intra-national inequalities. Policymakers and program managers should consider approaches to disaggregating effective coverage measures whenever possible in order to identify populations most at risk and target them for interventions that increase their effective coverage and improve maternal and child health outcomes.


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