PHA-Exchange> preventive interventions and implications for child-survival strategies

[claudio at hcmc.netnam.vn]

---- from "Ruggiero, Mrs. Ana Lucia (WDC)" <ruglucia at PAHO.ORG> -----
 
Co-coverage of preventive interventions and implications for
child-survival strategies: evidence from national surveys


Cesar G Victora, Bridget Fenn, Jennifer Bryce, Betty R Kirkwood
Lancet 2005; 366: 1460-66, October 22, 2005 
Universidade Federal de Pelotas, Pelotas, RS, Brazil and  London School
of Hygiene and Tropical Medicine, London, UK

Summary at:
http://www.thelancet.com/journals/lancet/article/PIIS014067360567599X/ab
stract

Professor Cesar G. Victora email: cvictora at terra.com.br 

In most low-income countries, several child-survival interventions are
being implemented. We assessed how these interventions are clustered at
the level of the individual child (Bangladesh, Benin, Brazil, Cambodia, 
Eritrea,Haiti, Malawi, Nepal, and Nicaragua). 

The percentage of children who did not receive a single intervention
ranged from 0*3% (14/5495) in Nicaragua to 18*8% (1154/6144) in
Cambodia. The proportions receiving all available interventions varied
from 0*8% (48/6144) in Cambodia to 13*3% (733/5495) in Nicaragua. There
were substantial inequities within all countries. In the poorest wealth
quintile, 31% of Cambodian children received no interventions and 17%
only one intervention; in Haiti, these figures were 15% and 17%,
respectively. 
Inequities were inversely related to coverage levels.
Countries with higher coverage rates tended to show bottom inequity
patterns, with the poorest lagging behind all other groups, whereas
low-coverage countries showed top inequities with the rich substantially
above the rest.

Interpretation 

The inequitable clustering of interventions at the level of the child
raises the possibility that the introduction of new technologies might
primarily benefit children who are already covered by existing
interventions. Packaging several interventions through a single delivery
strategy, while making economic sense, could contribute to increased
inequities unless population coverage is very high. Co-coverage analyses
of child-health surveys provide a way to assess these issues.

 

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