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Socioeconomic inequalities in skilled birth attendance and child stunting in selected low and middle income countries: Wealth quintiles or deciles?

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  • Kerry L M Wong
  • María Clara Restrepo-Méndez
  • Aluísio J D Barros
  • Cesar G Victora

Abstract

Background: Wealth quintiles derived from household asset indices are routinely used for measuring socioeconomic inequalities in the health of women and children in low and middle-income countries. We explore whether the use of wealth deciles rather than quintiles may be advantageous. Methods: We selected 46 countries with available national surveys carried out between 2003 and 2013 and with a sample size of at least 3000 children. The outcomes were prevalence of under-five stunting and delivery by a skilled birth attendant (SBA). Differences and ratios between extreme groups for deciles (D1 and D10) and quintiles (Q1 and Q5) were calculated, as well as two summary measures: the slope index of inequality (SII) and concentration index (CIX). Results: In virtually all countries, stunting prevalence was highest among the poor, and there were larger differences between D1 and D10 than between Q1 and Q5. SBA coverage showed pro-rich patterns in all countries; in four countries the gap was greater than 80 pct points. With one exception, differences between extreme deciles were larger than between quintiles. Similar patterns emerged when using ratios instead of differences. The two summary measures provide very similar results for quintiles and deciles. Patterns of top or bottom inequality varied with national coverage levels. Conclusion: Researchers and policymakers should consider breakdowns by wealth deciles, when sample sizes allow. Use of deciles may contribute to advocacy efforts, monitoring inequalities over time, and targeting health interventions. Summary indices of inequalities were unaffected by the use of quintiles or deciles in their calculation.

Suggested Citation

  • Kerry L M Wong & María Clara Restrepo-Méndez & Aluísio J D Barros & Cesar G Victora, 2017. "Socioeconomic inequalities in skilled birth attendance and child stunting in selected low and middle income countries: Wealth quintiles or deciles?," PLOS ONE, Public Library of Science, vol. 12(5), pages 1-17, May.
    • Handle: RePEc:plo:pone00:0174823
    DOI: 10.1371/journal.pone.0174823
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    References listed on IDEAS

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    1. Deon Filmer & Kinnon Scott, 2012. "Assessing Asset Indices," Demography, Springer;Population Association of America (PAA), vol. 49(1), pages 359-392, February.
    2. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
    3. Deon Filmer & Lant Pritchett, 2001. "Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India," Demography, Springer;Population Association of America (PAA), vol. 38(1), pages 115-132, February.
    4. Aluísio J D Barros & Cesar G Victora, 2013. "Measuring Coverage in MNCH: Determining and Interpreting Inequalities in Coverage of Maternal, Newborn, and Child Health Interventions," PLOS Medicine, Public Library of Science, vol. 10(5), pages 1-9, May.
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    1. Wong, Kerry L.M. & Brady, Oliver J. & Campbell, Oona M.R. & Banke-Thomas, Aduragbemi & Benova, Lenka, 2020. "Too poor or too far? Partitioning the variability of hospital-based childbirth by poverty and travel time in Kenya, Malawi, Nigeria and Tanzania," LSE Research Online Documents on Economics 103300, London School of Economics and Political Science, LSE Library.
    2. Conrad Murendo & Gamuchirai Murenje & Pepukai Prince Chivenge & Rumbidzai Mtetwa, 2021. "Financial Inclusion, Nutrition and Socio‐Economic Status Among Rural Households in Guruve and Mount Darwin Districts, Zimbabwe," Journal of International Development, John Wiley & Sons, Ltd., vol. 33(1), pages 86-108, January.

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