Table 2.
Summary of findings
| Authors (year of publication) | Factors identified as contributors to inequalities in access to and utilization of maternal, newborn and child health (MNCH) services in SSA | |||
|---|---|---|---|---|
| Antenatal care (ANC) | Postnatal care (PNC) | Skilled delivery | Newborn and child health services | |
| Birungi et al. (2011), Kenya |
PMTCT Pregnancy order: OR, 95% CI 0.5, 0.3–0.9 Husband support, 4.9, 1.8–13.1 |
Not applicable | Pregnancy order: OR, 95% CI 0.6, 0.4–0.9 | Not applicable |
| Taffa and Chepngeno (2005), Kenya | Not applicable | Not applicable | Not applicable | Lack of money (HH expenditure < 7431 Ksh): OR, 95% CI 2.2, 1.57–3.0 |
| Chege et al. (2002), Kenya | Not applicable | Not applicable | Not applicable | Reasons for non-immunization: lack of proper instruction by clinic staff, 0.8%; forgetting 0.8%; pressure of work 1.6%. Reasons for failure to seek treatment: lack of finance 71.4% and pressure of work: 28.6%. Focus group discussion: Use of intoxicants found to be an obstacle to health seeking for children |
| Tann et al. (2007), Uganda | Not applicable |
Crowding at home: < 3 years > 3 in the household: OR, 95% CI 1.96, 1.19–3.20 |
Lower education: OR, 95% CI 3.07, 1.49–6.31; Lack of electricity: 3.47, 1.51–7.97; Crowded household: 2.71, 1.42–5.16 |
Not applicable |
| Yaya et al. (2018), Ethiopia | Not applicable | Not applicable |
Education (primary versus none): OR, 95% CI 3.72, 2.50–5.54); Sec/higher 1.75, 1.30–2.35 Richest versus poorest: 4.97, 2.41–10.25 Age at first birth 18/18+ years < 18: 1.92, 1.44–2.55 |
Not applicable |
| Ndimbii et al. (2018), Kenya | Stigmatizing attitudes from health care workers, long waiting times | Not applicable | Lack of a holistic view of children health needs | |
| Ngandu et al. (2017), South Africa |
PMTCT The largest contributions to the observed inequality between low and high wealth groups were from: inequalities in province (contribution, 65.27%), age (44.38%), wealth group (24.73%) and transport means (21.61%) |
Not applicable | Not applicable | Not applicable |
| Mustapha et al. (2018), Uganda |
PMTCT HIV+ mothers: OR, 95%CI 18.2 (95% CI 9.0–36.7); Mothers aged 20–24 years 15–19 years: 1.9, 1.1–3.6; Stigma, financial constraints, non-disclosure, and lack of partner and family support were key demotivating factors |
Not applicable | Not applicable | Not applicable |
| Anastasi et al. (2017), Nigeria |
Stigma from healthcare Long waiting times |
Not applicable | Not applicable | |
| Adewuyi et al. (2017), Nigeria | Not applicable | Not applicable |
Home delivery Age ≥ 36 years vs 20-35 years: OR, 95% CI 0.77, 0.63–0.95; Education None vs secondary/higher: 1.52, 1.12, 1.94 Birth order: 1 vs ≥ 4: 0.58, 0.44–0.76 |
Not applicable |
| Antai (2010), Nigeria | Not applicable | Not applicable | Not applicable |
Full immunization: Urban migrant vs non-migrant: OR, 95%CI 1.54, 1.11–2.15 Differences in full immunization between the migrant and non-migrant groups partly explained by unequal utilization of health care services |
| Mekonnen and Mekonnen (2003), Ethiopia |
Primary vs no educ. OR, 95% CI 1.7, 1.0–3.0; Sec vs no educ. 3.8, 2.1–6.9 Married 2.4 (1.3–4.1) |
Not applicable | Primary versus no education: OR, 95% CI 2.3, 1.3–4.1; Sec vs no educ. 7.2, 4.1–12.5 | Not applicable |
| Owiti et al. (2018), Kenya | Not applicable |
Positive perception of the public health facility within closest proximity: OR, 95% CI 17.3, 4.5–66.6 Travelling by foot (ref = private car): 0.075, 0.019–0.293 Attending ANC at a private health facility (0.049, 0.012–0.196) and an NGO health facility (0.081, 0.028–0.235) |
Not applicable | |
| Adewuyi et al. (2018), Nigeria |
ANC underuse Lack of maternal education: AOR, 95% CI 1.44–1.10, 1.87 Poor HHs: 2.05, 1.51–2.79 Lack of husband’s education: 2.16, 1.68–2.75 Mothers age (ref = 35 years) < 20 years: 1.75, 1.13–2.70 & 20–34 years 1.25, 1.03–1.49) No access to health insurance 3.41, 1.53, 7.58 |
Not applicable | Not applicable | Not applicable |
| Kawakatsu et al. (2015), Kenya | Not applicable | Not applicable | Not applicable |
Full vaccination Highest wealth quintile: AOR, 95% CI 2.49, 1.33–4.64 Community with high media coverage devices 1.50, 1.029–2.198 Participation in the mass immunization campaigns: 1.63, 1.15–2.30 |
| Mutua et al. (2011), Kenya | Not applicable | Not applicable | Not applicable |
Full coverage Primary education, OR, 95%CI 1.30, 1.01–1.67) Mother age (ref < 20) 20-24 years: 1.48,1.06–2.08) & 25-29 years: 1.76, 1.18–2.62 Parity (ref = 1), parity 2: 0.66, 0.5–0.87; parity 3: 0.56, 0.41–0.78) Poverty |
| Machira and Palamulen (2017), Malawi | Not applicable | Access to care/services | Not applicable | Not applicable |
| Engodi et al. (2015), Kenya | Not applicable | Not applicable | Not applicable |
Contributor to overall inequality in immunization coverage across wealth quintiles Mother’s level of education Birth order Involvement in any income generating activity |
| Phiri et al. (2014), Kenya | Not applicable | Not applicable |
SES (low to high): OR, 95% CI 1.14, 1.09–1.16 ANC visits (0–9): 1.35, 1.00–1.81 |
Not applicable |
| Tanzania | Not applicable | Not applicable |
Trust quality (1–4): 1.63, 1.21–2.19 Perceived cost of care: 1.65, 1.15–2.37 |
Not applicable |
| Zambia | Not applicable | Not applicable |
High SES: 1.11.04–1.17 Single/divorced vs married 0.43, 0.21–0.88—perceived cost (not at all to very much (1–5): 1.31, 1.02–1.77 Perceived distance (low to high): 0.77, 0.66–0.90 |
Not applicable |
| Fotso et al. (2008), Kenya | Not applicable | Not applicable | The proportion of non-health facility deliveries steadily declined with education and wealth and increased with parity | Not applicable |
| Fotso et al. (2008), Kenya | Not applicable | Not applicable |
Secondary+ vs primary: OR, 95% CI 1.611, 1.29–2.02 Working vs not working: 1.31, 1.05, 1.63 HH wealth (ref = poorest): middle 1.26, 1.00–1.59 & least poor: 2.11, 1.63–2.75 |
Not applicable |
| Bayu et al. (2015), Ethiopia | Not applicable | Not applicable |
Unplanned home delivery Single women: AOR, 95% = 2.34, 1.17–4.68 Illiterate mothers: 6.14, 2.20–17.2 Absence of antenatal clinic visit for indexed pregnancy: 3.11, 1.72–5.61 Poor autonomy: 2.11, 1.27–3.49 Absence of birth preparedness and complication readiness: 3.83, 2.19–6.70 |
Not applicable |
| Kibiribiri et al. (2016), South Africa |
Refugees dislike facility due to health care workers’ xenophobia (43.6%), carelessness (42.3%), and inability to communicate with refugees (37.2%) Higher proportion of refugees did not receive enough information about labor and child birth (39.2% vs 24.4%), self-health care during pregnancy (44.6% vs 26.1%) |
Not applicable | Not applicable | Not applicable |
| Kimani-Murage et al. (2016), Kenya | Not applicable | Not applicable | Not applicable | AOR, 95% CI for EBF from birth to 6 months: 66.9, 45.4–96.4; 84.3, 40.7–174.6; and 3.9 (95% CI 1.8–8.4) for the MIYCN-intervention, MIYCN-control and comparison group, respectively, compared with the pre-intervention group |
| Kimani-Murage et al. (2014), Kenya | Not applicable | Not applicable | Not applicable |
Optimal breastfeeding Poverty, livelihood and living conditions (work e.g. commercial sex work, food insecurity, living arrangements, alcoholism—early and single motherhood Poor social and professional support Poor knowledge, myths and misconceptions HIV (fear of MCT, stigma) Unintended pregnancies |
| Mirkuzie (2014), Ethiopia | Not applicable | Not applicable |
Social influences, Physical access to health facility Risk perceptions Perceived quality of care and disrespectful care |
Not applicable |
| Aidam et al. 2005a, 2005b), Ghana | Not applicable | Not applicable | Not applicable |
Exclusive breastfeeding since birth Delivery at a hospital/polyclinic: R, 95% CI 1.96, 1.08–3.54) High socioeconomic status (women living in their own houses compared to those who rent): 3.96, 1.02–15.49 |
| Ochola et al. (2013), Kenya | Not applicable | Not applicable | Not applicable |
Exclusive breastfeeding Intervention versus control: ARR, 95% CI 4.01, 2.30–7.01 |
| Aidam et al. (2005a, 2005b), Ghana | Not applicable | Not applicable | Not applicable | The percentage of exclusive breastfeeding during the 6 month significantly higher among Intervention Group1 and Intervention Group 2 (39.5%) than among control group (19.6%) |
| Bellows et al. (2012), Kenya |
Any ANC visit Purchase of voucher: OR, 95% CI 11.4, 4.3–42.9 |
Not applicable |
Facility based delivery Age 23–34 versus 12–23: OR, 95% CI 1.2, 1.04–1.47 Secondary education: 1.6, 1.28–1.98 Least poor 1.3, 1.15–1.53 Facility based delivery (12.9, 8.9–19.3) & skilled birth delivery (1.2, 1.1–1.4) increased during the voucher programme period |
Not applicable |
| Olusanya et al. (2010), Nigeria | Not applicable | Not applicable |
Delivery outside hospital Teenage mothers: OR, 95% CI 1.63, 1.12–2.37 No education: 3.45, 2.18–5.45 Primary education: 2.19, 2.13–3.66 Secondary education: 1.71, 1.37–2.14 Unemployed: 1.31, 1.05–1.63 Belonging to low social class: 1.51, 1.02–2.44 or middle 1.61, 1.12–2.33 Living in accommodation with shared sanitation facilities: 2.031.67–2.48 Being multiparous: 1.58, 1.27–1.97 Lack of skilled birth delivery Belonging to low (2.31; 1.07–4.97), or middle (2.53, 1.21–5.27) social class |
Not applicable |
| Izugbara et al. (2009), Kenya | Not applicable |
Barriers to hospital based delivery Very exorbitant and often out of their reach Hospital-based providers characterized as harsh and uncaring, Physical proximity of services Fear of HIV testing and counselling |
Not applicable | |
| Rossier et al. (2014), Kenya |
ANC use at least 1 visit Women with the least education: OR, 95% CI 0.36, 0.15–0.87; Not poor: 2.35, 1.39–3.96 Living in the wealthier area 0.56 0.321–0.989 Increase parity decreased ANC visit |
Not applicable |
Skilled delivery increased with Increased education Antenatal care attendance |
Not applicable |
| Burkina Faso |
ANC at least 4+ visit Not poor 1.54, 1.22–1.94; Secondary education 1.59, 1.21–2.10 |
Not applicable | Secondary education increased skilled birth delivery | Not applicable |
| Belayneh et al. (2014), Ethiopia |
Early ANC visit Younger age: AOR, 95% CI 3.83, 1.8 9–10.53 Formal education: 1.06, 1.03–7.61 Early ANC visit: 2.39, 2.23–9.86 |
Not applicable | Not applicable | Not applicable |
| Babirye et al. (2014), Uganda | Not applicable | Not applicable | Not applicable |
Low utilization of immunization services Lack of financial support for immunization activities—intermittent availability of vaccines and transport for immunization services at both private and public facilities |
| Fatiregun and Okoro (2012), Nigeria | Not applicable | Not applicable | Not applicable |
Complete immunization status Maternal age < 30 years: AOR, 95% CI 2.26, 1.27–4.03 Availability of an immunization card at first contact: 7.724.43–13.44 < 3 children: 2.22, 11.1–4.42 Completion of post-secondary education: 2.34,1.12–4.47 Maternal unemployment 1.71, 1.01–2.89 |
| Idowu et al. (2017), Nigeria | Not applicable | Not applicable |
Skilled birth attendance Maternal age ≤ 19 years: AOR, 95% CI 0.03, 0.003–0.25 Higher education: 10.94, 3.60–33.26 Having only one child: 4.33, 1.18–15.82 Having ≤ 4 ANC attendance Residing near delivery sites |
Not applicable |
| Demilew (2017), Ethiopia, Ethiopia | Not applicable | Not applicable | Not applicable |
Knowledge on infant feeding Education beyond primary education: AOR, 95% CI 2.5, 1.5–3.9 Possession of radio 1.7, 1.1–2.7 Antenatal care attendance: 2.4, 1.5–4.0 Having an employed husband: 2.3, 1.2, 4.4 |
| Adane et al. (2017), Ethiopia | Not applicable | Not applicable | Not applicable |
Health seeking behaviors for under-5 children with acute diarrhea Literacy of mother: OR, 95%CI 2.4, 1.4–4.1 Occupation of mothers/caregiver: 2.6, 5–4.6 Household monthly income ≥ 50 US$: 2.9; 1.5–5.6 Availability of nearest health facilities within 15 min walking distance: 3.3, 1.7–6.6 |
| Abimbola et al. (2016), Nigeria |
Barriers to the utilization of ANC Lack of money Enhancers of utilization level of education, employment status and higher parity |
Not applicable | Not applicable | Not applicable |
| Wakwoya et al. (2016), Ethiopia | Not applicable | Not applicable |
Infant feeding Higher education: AOR, 95% CI 5.3, 1.25–22.1 Antenatal care attendance: 5.5, 1.5–20.16 On anti-retro viral therapy (ART): 6.5, 1.88–22.51 Disclosed HIV status: 7.1, 1.26–39.76) |
|
| Wilunda et al. (2016), South Sudan | Not applicable | Not applicable |
Barriers to institutional childbirth Access and lack of resources e.g. long distance to health facilities, lack of transportation means, referral problems Socio-cultural context and conflict: e.g. insecurity, influence of the husband, lack of birth preparedness Perceptions about pregnancy and childbirth e.g. perceived benefit of institutional childbirth Perceptions about the quality of care |
Not applicable |
| Kuwawenaruwa et al. (2016), Tanzania | Not applicable | Not applicable |
Decision about where to deliver Individual factors e.g. complications during previous pregnancy, male involvement in decision-making Financial factors e.g. cost of transportation, other costs Health system factors e.g. providers and client relationship |
Not applicable |
| Woldeghebriel et al. (2017), Ghana | Not applicable | Not applicable | Not applicable |
Early breastfeeding for ≥ 6 months Borrowing money from a neighbor or family member: OR, 95% CI 1.53, 1.05, 2.23 Liberian refugees living in Ghana for 8 years or more (ref: Ghanaians): 1.78, 1.02, 3.09 |
| Jennings et al. (2017), Ghana & Nigeria | Not applicable | Not applicable |
Skilled delivery Women in household with savings: AOR, 95% CI 2.81, 1.25–6.33 > 3 positive economic characteristics 2.69, 1.21–5.99 |
Not applicable |
| Bayou et al. (2016), Ethiopia |
Adequate ANC visit/care Higher education: OR, 95% CI 2.69, 1.29–5.63 Never-married/formerly married women: 0.38, 0.20–0.73 ANC follow ups in private facilities 2.16, 1.02–4.49 |
Not applicable | Not applicable | Not applicable |
| Sasaki et al. (2010), Zambia | N/A | N/A |
Care seeking for danger signs in children-baseline Lower-income OR, 95% CI = 0.47, 0.25–087 farthest distance 0.30, 0.13–0.66 3 years after the intervention Frequent attendance at growth monitoring sessions (ref:4–6 times): –No attendance 0.31, 0.15–0.65 –1–3 attendance 0.43, 0.22–0.88 |
|
|
Westheimer et al. (2004), Tanzania |
PMTCT-odds of accepting HIV testing Aged 20–24 years: OR, 95%CI 0.90, 0.78–1.03 Unknown spouse’s occupation: 1.41, 1.15–1.71 Cohabiting with the partner: 1.14, 1.03–1.26 Higher education: 0.79, 0.64, 0.96 3 children living at home: 0.83, 0.72, 0.97 |
Not applicable | Not applicable | Not applicable |
| Nwameme et al. (2014), Ghana |
Noncompliance with maternal referrals Major causes include: financial problems (46.2%), attitude of nurses at the referral centers (10.8%), fear of surgery (7.7%) and distance to referral centers (4.6%) |
Not applicable | Not applicable | Not applicable |
| Asundep et al. (2013), Ghana |
ANC attendance influenced by Cost: AOR, 95% CI 1.86, 1.04–3.32 Distance to health facility: 2.24, 1.00–5.03 Cultural beliefs: 2.59, 0.95–7.08 |
Not applicable | Not applicable | Not applicable |
| Sasaki et al. (2010), Zambia | Not applicable | Not applicable | Not applicable |
Access to immunization Longer distances to a service point → immunization coverage of DPT3: OR, 95% CI 0.24, 0.10–0.56 and measles 0.38, 0.17–0.82 Female headed household: 0.42, 0.19–0.95 After intervention, distance and HH head were no more associated with immunization overage |
| Fotso et al. (2009), Kenya | Not applicable | Not applicable |
Deliver in appropriate health facilities—among middle and least poor households, high overall autonomy women were slightly more likely to deliver in appropriate health facilities Delivery at equipped health facility associated with: increased education, ANC counseling, wanted pregnancies. Age < 25 years & increase parity |
Not applicable |
| Govender et al. (2019), South Africa |
Use of ANC influenced by Emotional vulnerability, i.e. fear, loneliness, shame and disgrace Financial barriers Attitude of health care workers, long queues at health facilities, and long distance to health facilities Level of education |
Not applicable | Not applicable | Not applicable |