Equity in maternal and child health in Thailand.
OBJECTIVE
To assess equity in health outcomes and interventions for maternal and child health (MCH) services in Thailand.


METHODS
Women of reproductive age in 40 000 nationally representative households responded to the Multiple Indicator Cluster Survey in 2005-2006. We used a concentration index (CI) to assess distribution of nine MCH indicator groups across the household wealth index. For each indicator we also compared the richest and poorest quintiles or deciles, urban and rural domiciles, and mothers or caregivers with or without secondary school education.


RESULTS
CHILD UNDERWEIGHT (CI: -0.2192; P < 0.01) and stunting (CI: -0.1767; P < 0.01) were least equitably distributed, being disproportionately concentrated among the poor; these were followed by teenage pregnancy (CI: -0.1073; P < 0.01), and child pneumonia (CI: -0.0896; P < 0.05) and diarrhoea (CI: -0.0531; P < 0.1). Distribution of the MCH interventions was fairly equitable, but richer women were more likely to receive prenatal care and delivery by a skilled health worker or in a health facility. The most equitably distributed interventions were child immunization and family planning. All undesirable health outcomes were more prevalent among rural residents, although the urban-rural gap in MCH services was small. Where mothers or caregivers had no formal education, all outcome indicators were worse than in the group with the highest level of education.


CONCLUSIONS
Equity of coverage in key MCH services is high throughout Thailand. Inequitable health outcomes are largely due to socioeconomic factors, especially differences in the educational level of mothers or caregivers.
Khon Kaen University, Thanon Mitraparp, Amphoe Muang, Khon Kaen, 40002, Thailand. supon@kku.ac.th
Supon
S
Limwattananon
Viroj
V
Tangcharoensathien
Phusit
P
Prakongsai
D000293:Adolescent; D000328:Adult; D017028:Caregivers; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D005843:Geography; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007229:Infant Welfare / Q000706:statistics & numerical data*; D008297:Male; D044342:Malnutrition / Q000453:epidemiology*; D008429:Maternal Welfare / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D012959:Socioeconomic Factors; D013785:Thailand / Q000453:epidemiology; D016896:Treatment Outcome; D019472:Universal Health Insurance / Q000706:statistics & numerical data; D055815:Young Adult