02 May 2014 Assessing inequality in reproductive, maternal and
child health in Lao PDR Slide 2 Indicators Antenatal care (at least
one visit) Careseeking for pneumonia DPT3 immunization Early
initiation of breastfeeding Measles immunization Oral rehydration
therapy for children with diarrhoea Births attended by skilled
health personnel Stunting (height for age) in children under 5
years Underweight (weight for age) in children under 5 years
Wasting (weight for height) in children under 5 years Slide 3
Dimensions of inequality Wealth Education Sex Area. Slide 4 Each
indicator, three aspects will be assessed 1. The latest status
(from MICS 2011) 2. The time trend (2006 to 2011) 3. Benchmarking
against other countries in the Asia Pacific Region Slide 5 Example
for HD*calc analysis of latest status Indicator Education 2011
AbsoluteRelative Antenatal care (at least one visit) 49.5223.140
Careseeking for pneumonia 34.7861.860 DPT3 immunization 38.6802.160
Early initiation of breastfeeding 14.9311.479 Measles immunization
30.2911.674 Oral rehydration therapy for children with diarrhoea
17.2091.329 Births attended by skilled health personnel 47.7863.973
Stunting (height for age) in children under 5 years 23.8951.703
Underweight (weight for age) in children under 5 years 14.6531.722
Wasting (weight for height) in children under 5 years 0.8941.154 -
Slop index inequality(SII) and Relative concentration
index(RCI)were selected for wealth stratifier - Range different(RD)
and relative different(RR) were sected for education, sex and area.
Absolute : If the value 0-20=1 Absolute : If the value 21-40=2
Absolute : If the value41-100=3 Relative: If the RR value 0-1.16=1
Relative: If the RR value 1.17-1.75=2 Relative: If the RR value
1.76-20=3 Slide 6 The latest status of inequality In 2011,
indicators showed less than 60% in coverage and only 3 of the 10
indicators showed higher than 50%(ANC1,DPTV and Carep). Births
attended by skilled health personnel showed greatest level of
inequality across the 4 stratifiers (wealth-based, education based,
sex based and area-based), And ANC1 is also showed high level of
inequality as second Slide 7 Indicator National average Inequality
WealthEducationSexArea 2015
AbsoluteRelativeAbsoluteRelativeAbsoluteRelativeAbsoluteRelative
2011 avg Antenatal care (at least one visit) 13133na 235554
Careseeking for pneumonia 231231122 DPT3 immunization 131231112
Early initiation of breastfeeding 12112na 22 Measles immunization
3212211129063 Oral rehydration therapy for children with diarrhoea
111221112 Births attended by skilled health personnel 33133na
3350%42 RMCH interventions 21231122 Stunting (height for age) in
children under 5 years 2312211233444 Underweight (weight for age)
in children under 5 years 2211211132227 Wasting (weight for height)
in children under 5 years 111111211 6 CH outcomes 21121112 3 (red)
indicated urgent need for action, 2 (yellow) indicated that action
is needed 1 (green) indicated that no action is needed. The most
inequitable health services indicator across all equity stratifiers
assessed was the presence of a skilled birth attendant Prioritizing
the latest status of inequality and national coverage Slide 8
Prioritizing the latest status of inequality and national coverage
Urgent need for action. Births attended by skilled health personnel
Measles immunization Need for action. Antenatal care (at least one
visit) Stunting (height for age) in children under 5 years
Underweight (weight for age) in children under 5 years Slide 9 Most
of indicators the trend of the inequality by stratifiers were no
change or slight change and dont show large gap of inequality over
5 years. ANC, DPTV and SBA showed highest inequality of absolute
number. The largest increase in coverage was seen in measles
immunization by 20% from 2006 to2011. Care seeking for pneumonia
and early initiation of breastfeeding show second and third
respectively and the rest indicators were slightly changed. Trend
of Inequality by Stratifiers Slide 10 Example table for trend
analyzed by HD*calc For wealth-based Indicator Inequality Wealth
20062011AbsoluteRelative
Absolute(SII)Relative(RCI)Absolute(SII)Relative(RCI) Antenatal care
(at least one visit) 73.6560.33088.3730.25914.717-0.071 Careseeking
for pneumonia 36.2840.17447.4710.13411.187-0.040 DPT3 immunization
37.7330.14455.3540.15917.6210.015 Early initiation of breastfeeding
31.8880.16822.4920.092-9.396-0.076 Measles immunization
29.9120.11839.8460.1009.934-0.018 ORT
9.1650.02815.7750.0416.6100.013 Births attended by skilled health
personnel 73.1440.56898.1880.37625.044-0.192 Stunting (height for
age) in children under 5 years
-35.410-0.118-49.961-0.179-14.551-0.061 Underweight (weight for
age) in children under 5 years
-23.975-0.120-29.543-0.176-5.568-0.056 Wasting (weight for height)
in children under 5 years 0.5420.012-1.782-0.048-2.324-0.060 Slide
11 Prioritizing the time trend of inequality and national coverage
Indicator National average Inequality WealthEducationSexAreaAverage
inequality score
AbsoluteRelativeAbsoluteRelativeAbsoluteRelativeAbsoluteRelativeAbsoluteRelative
Antenatal care (at least one visit) 23111na 111.71.0 Careseeking
for pneumonia 2211111211.51.0 DPT3 immunization 2322211111.81.5
Early initiation of breastfeeding 21111na 211.31.0 Measles
immunization 1212121111.81.0 Oral rehydration therapy for children
with diarrhoea 2222111111.51.3 Births attended by skilled health
personnel 13111na 111.71.0 RMCH interventions 21111111 Stunting
(height for age) in children under 5 years 2112122221.81.5
Underweight (weight for age) in children under 5 years
2111111121.01.3 Wasting (weight for height) in children under 5
years 2112222221.8 CH outcomes 11212222 3 (red) indicated urgent
need for action, 2 (yellow) indicated that action is needed 1
(green) indicated that no action is needed. Slide 12 Examples on
trend of inequity in health (1) Slide 13 Prioritizing the trend of
inequality and national coverage Need for action: Antenatal care
(at least one visit) Careseeking for pneumonia DPT3 immunization
Early initiation of breastfeeding Oral rehydration therapy for
children with diarrhoea Stunting (height for age) in children under
5 years Underweight (weight for age) in children under 5 years
Wasting (weight for height) in children under 5 years Slide 14
Benchmarking The red dot indicate the value of Lao PDR Slide 15
Example: Oral rehydration therapy for children with diarrhea Slide
16 Benchmarking Indicator National average Inequality Wealth
AbsoluteRelative Antenatal care (at least one visit) 333
Careseeking for pneumonia 333 DPT3 immunization 333 Early
initiation of breastfeeding 333 Measles immunization 333 Oral
rehydration therapy for children with diarrhoea 122 Births attended
by skilled health personnel 333 RMCH interventions 33 Stunting
(height for age) in children under 5 years 333 Underweight (weight
for age) in children under 5 years 222 Wasting (weight for height)
in children under 5 years 121 CH outcomes 22 3 (red) indicated
urgent need for action, 2 (yellow) indicated that action is needed
1 (green) indicated that no action is needed. Slide 17 conclusion
Births attended by skilled health personnel and Antenatal care (at
least one visit) showed greatest level of inequality across the 4
stratifiers Most of the indicator when compared to other countries
in the Asia Pacific Region, Laos had the highest absolute
wealth-based inequality in our assess inequitable health services
indicator across all equity stratifiers with low coverage 8 0f 10
indicators. Slide 18 Conclusion Urgent action should be taken for
these indicators below: Antenatal care ( at least one visit) Births
attended by skilled health personnel Careseeking for pneumonia DPT3
immunization Early initiation of breastfeeding Stunting (height for
age) in children under 5 years Underweight (weight for age) in
children under 5 years
