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Current Status, Trends, and International Comparison of Health Inequalities in Maternal and Child Health Indicators in Cambodia. May 1 st 2014 Cambodian Team facilitated by Prof. Khang Health Inequality Monitoring Workshop. Table of Contents. Background Objectives Methods Results

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Current Status, Trends, and International Comparison of Health Inequalities in Maternal and Child Health Indicators in Cambodia

May 1st2014

Cambodian Team facilitated by Prof. Khang

Health Inequality Monitoring Workshop


Table of contents
Table of Contents Health Inequalities in Maternal and Child Health Indicators in Cambodia

  • Background

  • Objectives

  • Methods

  • Results

  • Discussion

  • Conclusion


I background
I. BACKGROUND Health Inequalities in Maternal and Child Health Indicators in Cambodia

  • Cambodia has made improvement in maternal and child health which were monitored by using predefined health indicators.

  • Access to health care for all remains major challenges in Cambodia.

  • With limited financial health protection, disadvantaged population was less likely to access health services than better off.

  • However, the health inequality among people from different demographic and socio-economic status was not documented by previous studies.


Ii objectives
II. OBJECTIVES Health Inequalities in Maternal and Child Health Indicators in Cambodia

  • To monitor current status and trends of inequality in maternal and child health indicators across various socio-economics factors, educational levels, residential locations, and regions.

  • To identify the inequality of maternal and child health services delivery between Cambodia and other countries with similar context.


Iii methods
III. METHODS Health Inequalities in Maternal and Child Health Indicators in Cambodia


Data source and health indicators
Data Source and Health Indicators Health Inequalities in Maternal and Child Health Indicators in Cambodia

  • Data source:

    Cambodia Demographic and Health Surveys in 2000, 2005, and 2010.

  • Health indicators:

    Family planning needs satisfied (FP), contraceptive prevalence of modern methods (CPM), contraceptive prevalence of modern and traditional methods (CPMT), antenatal care at least one visit (ANC1), antenatal care at least four visits (ANC4), births attended by skilled health personnel (SBA), early initiation of breastfeeding (EIBF), DPT3 immunization (DPT3), careseeking for pneumonia (CSP), and stunting in children under 5 years (Stu5)


Inequality stratifiers
Inequality Health Inequalities in Maternal and Child Health Indicators in Cambodia Stratifiers

  • Wealth index

    Richest, richer, middle, poorer, and poorest

  • Education

    None, primary, and secondary/higher

  • Area

    Urban and rural

  • Region

    All provinces in Cambodia


Measures for health inequality analysis
Measures for Health Inequality Analysis Health Inequalities in Maternal and Child Health Indicators in Cambodia

  • Absolute inequality

    • Range difference

    • Between range variances

    • Slope index of inequality

  • Relative inequality

    • Range ratio

    • Theil index

    • Relative concentration index

  • Scaling of action taken

    • 1: no action

    • 2: action is needed

    • 3: action is urgently needed


Iv results
IV-RESULTS Health Inequalities in Maternal and Child Health Indicators in Cambodia


Table 1 time trend of health indicators and inequality stratifiers
Table 1: Time Trend of Health Indicators and Inequality Health Inequalities in Maternal and Child Health Indicators in Cambodia Stratifiers

1: no action; 2: action is needed; 3: action is urgently needed


Table 2 latest status of health indicators and inequality stratifiers
Table 2: Latest Status of Health Indicators and Inequality Health Inequalities in Maternal and Child Health Indicators in Cambodia Stratifiers

1: no action; 2: action is needed; 3: action is urgently needed


Figure 1 inequality of anc 4 visits by wealth index
Figure 1: Inequality of ANC 4 Visits by Wealth Index Health Inequalities in Maternal and Child Health Indicators in Cambodia

Absolute inequality of ANC4 visit by wealth index was significantly increased from 2000 to 2010 (Slope index of inequality 24.2 in 2000, 45.2 in 2005, and 46.7 in 2010).


Figure 2 inequality of anc 4 visit by educational levels
Figure 2: Inequality of ANC 4 Visit by Educational Levels Health Inequalities in Maternal and Child Health Indicators in Cambodia


Figure 3 anc 4 visits by regions
Figure 3: ANC 4 Visits by Regions Health Inequalities in Maternal and Child Health Indicators in Cambodia

Absolute inequality of ANC4 visit by region measured by between group variance increased from 122.9 in 2005 to 186.6 in 2010


Table 3 results of benchmarking of inequality in health service delivery
Table 3: Results of Benchmarking of Inequality in Health Service Delivery

1: no action; 2: action is needed; 3: action is urgently needed


According figure 4 and 5, action is needed for ANC 4 visits, based on comparison with other countries within the same region


Summary of remarkable results
Summary of Remarkable Results based on comparison with other countries within the same region

  • In general, inequality of maternal and child health indicators based on time trend and latest status analysis was decreased.

  • Inequality of ANC 4 visits was significantly increased all inequality stratifiers.

  • Inequality mostly presented by region, particularly contraceptive prevalence (modern methods), antenatal care (at least four visits), and births attended by skilled health personnel.

  • In comparison with other countries within the region, inequality of maternal and child health was not high that urgently needs to take action.


V discussions
V-DISCUSSIONS based on comparison with other countries within the same region


Inequality of anc 4 visit
Inequality of ANC 4 Visit based on comparison with other countries within the same region

Inequality of ANC 4 visits was increased in all inequality stratifiers due to lack of financial health protection and low educational level for poor and vulnerable population.

Multi-sectoral collaborations and interventions are urgently required.


Inequality of health services by region
Inequality of Health Services by Region based on comparison with other countries within the same region

Inequality mostly presented by region across all inequality stratifiers.

  • Inequality of maternal and child health tended to decrease, but due to low use of health services by few provinces, health inequality remains significantly large.

    Urgently take action to increase health service utilization in those provinces in terms of promoting service availability, accessibility, and acceptibility.


Benchmarking
Benchmarking based on comparison with other countries within the same region

In comparison with other countries within the region, Cambodia seems not need to take any urgent action to minimize the inequality of maternal and child health services.

  • Inequality of those services remain approximately 40 percent.

  • Take into account the equity in health policy through promoting health service utilization in line with health inequality monitoring.


Vi conclusion
VI- CONCLUSION based on comparison with other countries within the same region

  • Inequality of ANC 4 visits was increased across all inequality stratifiers.

  • Inequality of all indicators remain large across provinces due to the low service coverage in few provinces.

  • Although, Cambodia seems not need to take any urgent action to minimize the inequality in comparison with other countries within region, inequality remain large.

    • Introducing the equity in health policy and practices through promoting health service utilization in line with health inequality monitoring.


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