Decomposition of socioeconomic inequalities in the uptake of intermittent preventive treatment of malaria in pregnancy in Nigeria: evidence from Demographic Health Survey

Chijioke Ifeanyi Okoli; Mohammad Hajizadeh; Mohammad Mafizur Rahman; Rasheda Khanam

doi:10.1186/s12936-021-03834-8

Decomposition of socioeconomic inequalities in the uptake of intermittent preventive treatment of malaria in pregnancy in Nigeria: evidence from Demographic Health Survey

Malar J. 2021 Jul 3;20(1):300. doi: 10.1186/s12936-021-03834-8.

Authors

Chijioke Ifeanyi Okoli^{1

2}, Mohammad Hajizadeh³, Mohammad Mafizur Rahman⁴, Rasheda Khanam⁴

Affiliations

¹ School of Business, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia. chijioke.okoli@usq.edu.au.
² Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria. chijioke.okoli@usq.edu.au.
³ School of Health Administration, Dalhousie University, Halifax, Canada.
⁴ School of Business, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.

Abstract

Background: Although malaria in pregnancy is preventable with the use of intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP), it still causes maternal morbidity and mortality, in sub-Saharan Africa and Nigeria in particular. Socioeconomic inequality leads to limited uptake of IPTp-SP by pregnant women and is, therefore, a public health challenge in Nigeria. This study aimed to measure and identify factors explaining socioeconomic inequality in the uptake of IPTp-SP in Nigeria.

Methods: The study re-analysed dataset of 12,294 women aged 15-49 years from 2018 Nigeria Demographic Health Survey (DHS). The normalized concentration index (C_n) and concentration curve were used to quantify and graphically present socioeconomic inequalities in the uptake of IPTp-SP among pregnant women in Nigeria. The C_n was decomposed to identify key factors contributing to the observed socioeconomic inequality in the uptake of adequate (≥ 3) IPTp-SP.

Results: The study showed a higher concentration of the adequate uptake of IPTp-SP among socioeconomically advantaged women (C_n = 0.062; 95% confidence interval [CI] 0.048 to 0.076) in Nigeria. There is a pro-rich inequality in the uptake of IPTp-SP in urban areas (C_n = 0.283; 95%CI 0.279 to 0.288). In contrast, a pro-poor inequality in the uptake of IPTp-SP was observed in rural areas (C_n = - 0.238; 95%CI - 0.242 to - 0.235). The result of the decomposition analysis indicated that geographic zone of residence and antenatal visits were the two main drivers for the concentration of the uptake of IPTp-SP among wealthier pregnant women in Nigeria.

Conclusion: The pro-rich inequalities in the uptake of IPTp-SP among pregnant women in Nigeria, particularly in urban areas, warrant further attention. Strategies to improve the uptake of IPTp-SP among women residing in socioeconomically disadvantaged geographic zones (North-East and North-West) and improving antenatal visits among the poor women may reduce pro-rich inequality in the uptake of IPTp-SP among pregnant women in Nigeria.

Keywords: Concentration index; Decomposition analysis; Inequalities; Intermittent preventive treatment in pregnancy; Malaria; Nigeria; Socioeconomic.

MeSH terms

Adolescent
Adult
Antimalarials / administration & dosage*
Drug Combinations
Female
Healthcare Disparities / statistics & numerical data
Humans
Malaria / prevention & control*
Middle Aged
Nigeria
Patient Acceptance of Health Care / statistics & numerical data*
Pregnancy
Pregnancy Complications, Parasitic / prevention & control*
Pyrimethamine / administration & dosage*
Socioeconomic Factors*
Sulfadoxine / administration & dosage*
Young Adult

Substances

Antimalarials
Drug Combinations
fanasil, pyrimethamine drug combination
Sulfadoxine
Pyrimethamine