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<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><font
size=2 color=maroon face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:maroon;font-weight:bold'>Co-coverage of preventive interventions and
implications for child-survival strategies: <br>
evidence from national surveys<o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><i><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-style:italic'><o:p> </o:p></span></font></i></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><i><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-style:italic'>Cesar G Victora, Bridget Fenn, Jennifer
Bryce, Betty R Kirkwood<o:p></o:p></span></font></i></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><b><i><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold;font-style:italic'>Lancet </span></font></i></b><b><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399;font-weight:bold'>2005; 366: 1460–66, October 22,
2005 <o:p></o:p></span></font></b></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'>Universidade Federal de Pelotas, <st1:City w:st="on">Pelotas</st1:City>,
RS, <st1:country-region w:st="on">Brazil</st1:country-region> and London
School of Hygiene and Tropical Medicine, <st1:place w:st="on"><st1:City w:st="on">London</st1:City>,
<st1:country-region w:st="on">UK</st1:country-region></st1:place><o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399'>Summary
at: <a
href="http://www.thelancet.com/journals/lancet/article/PIIS014067360567599X/abstract"><font
color="#333399"><span style='color:#333399'>http://www.thelancet.com/journals/lancet/article/PIIS014067360567599X/abstract</span></font></a>
<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399'><o:p> </o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><font size=2 color="#333399"
face=Arial><span lang=PT-BR style='font-size:10.0pt;font-family:Arial;
color:#333399'>Professor Cesar G. Victora email: </span></font><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
color:#333399'><a href="mailto:cvictora@terra.com.br"><font color="#333399"><span
lang=PT-BR style='color:#333399'>cvictora@terra.com.br</span></font></a></span></font><font
size=2 color="#333399" face=Arial><span style='font-size:10.0pt;font-family:
Arial;color:#333399'> <span lang=PT-BR><o:p></o:p></span></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
margin-left:.5in;line-height:13.5pt'><font size=2 color="#333399" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#333399'>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.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><b><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399;
font-weight:bold'>Methods</span></font></b><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399'> <o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
margin-left:.5in;line-height:13.5pt'><font size=2 color="#333399" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#333399'>We analysed data from <st1:country-region
w:st="on">Bangladesh</st1:country-region>, <st1:country-region w:st="on">Benin</st1:country-region>,
<st1:country-region w:st="on">Brazil</st1:country-region>, <st1:country-region
w:st="on">Cambodia</st1:country-region>, <st1:country-region w:st="on">Eritrea</st1:country-region>,
<st1:country-region w:st="on">Haiti</st1:country-region>, <st1:country-region
w:st="on">Malawi</st1:country-region>, <st1:country-region w:st="on">Nepal</st1:country-region>,
and <st1:country-region w:st="on"><st1:place w:st="on">Nicaragua</st1:place></st1:country-region>.
A co-coverage score was obtained by adding the number of interventions received
by each child (including BCG, diphtheria-pertussis-tetanus, and measles
vaccines), tetanus toxoid for the mother, vitamin A supplementation, antenatal
care, skilled delivery, and safe water. Socioeconomic status was assessed
through principal components analysis of household assets, and concentration
indices were calculated.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><b><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399;
font-weight:bold'>Findings</span></font></b><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399'> <o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
margin-left:.5in;line-height:13.5pt'><font size=2 color="#333399" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#333399'>The percentage of
children who did not receive a single intervention ranged from 0·3%
(14/5495) in <st1:country-region w:st="on">Nicaragua</st1:country-region> to
18·8% (1154/6144) in <st1:country-region w:st="on"><st1:place w:st="on">Cambodia</st1:place></st1:country-region>.
The proportions receiving all available interventions varied from 0·8%
(48/6144) in <st1:country-region w:st="on">Cambodia</st1:country-region> to
13·3% (733/5495) in <st1:country-region w:st="on"><st1:place w:st="on">Nicaragua</st1:place></st1:country-region>.
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 <st1:country-region w:st="on"><st1:place w:st="on">Haiti</st1:place></st1:country-region>,
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.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in'><b><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399;
font-weight:bold'>Interpretation</span></font></b><font size=2 color="#333399"
face=Arial><span style='font-size:10.0pt;font-family:Arial;color:#333399'> <o:p></o:p></span></font></p>
<p class=MsoNormal style='mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;
margin-left:.5in;line-height:13.5pt'><font size=2 color="#333399" face=Arial><span
style='font-size:10.0pt;font-family:Arial;color:#333399'>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.<o:p></o:p></span></font></p>
<p class=MsoNormal style='margin-left:.5in;text-autospace:none'><font size=2
color="#333399" face=Arial><span style='font-size:10.0pt;font-family:Arial;
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