Economic-related inequalities in child health interventions: An analysis of 65 low- and middle-income countries

To achieve Sustainable Development Goal targets related to child health and well-being, it is important to quantify inequalities in the essential child health interventions. We used the latest available Demographic and Health Surveys from 65 low-income and middle-income countries between 2005 and 2018. We examined economic-related inequalities in 15 essential child health interventions spanning across four domains: nutrition, behavioral health, household environment, and maternal factors. In the pooled analysis, we observed significant inequalities in all child health interventions, except in the use of oral rehydration therapy (ORT) for child diarrhea. The interventions with the largest adjusted difference between the richest (Q5) and the poorest (Q1) groups were in household environment domain: improved sanitation at 55.6 percentage points [PPs] (95% confidence interval [CI]: 54.7, 56.6), low indoor pollution at 43.5 PPs (95% CI: 41.4, 45.9), and safe stool disposal at 39.8 PPs (95% CI: 38.7, 41.0). In 35 countries, the adjusted difference between Q5 and Q1 groups in improved sanitation was found to be larger than 50 PPs. At the same time, country-specific analyses revealed substantial heterogeneity in the extent of inequalities in child health interventions. An inverted-U shape curve was identified between the mean intervention coverage rate and the magnitude of inequalities for household environmental and maternal interventions. This suggests an initial exacerbation of inequality in child health interventions as the coverage increases until it reaches an inflection point at which inequality begins to decline even as the coverage continues to improve. Our findings call for more systematic monitoring of economic-related inequalities in child health interventions to develop equity-oriented policies and programmes in global health.