title: How changes in coverage affect equity in maternal and child health interventions in 35 Countdown to 2015 countries: an analysis of national surveys.
abstract: BACKGROUND
  Achievement of global health goals will require assessment of progress not only nationally but also for population subgroups. We aimed to assess how the magnitude of socioeconomic inequalities in health changes in relation to different rates of national progress in coverage of interventions for the health of mothers and children.
  
  
  METHODS
  We assessed coverage in low-income and middle-income countries for which two Demographic Health Surveys or Multiple Indicator Cluster Surveys were available. We calculated changes in overall coverage of skilled birth attendants, measles vaccination, and a composite coverage index, and examined coverage of a newly introduced intervention, use of insecticide-treated bednets by children. We stratified coverage data according to asset-based wealth quintiles, and calculated relative and absolute indices of inequality. We adjusted correlation analyses for time between surveys and baseline coverage levels.
  
  
  RESULTS
  We included 35 countries with surveys done an average of 9·1 years apart. Pro-rich inequalities were very prevalent. We noted increased coverage of skilled birth attendants, measles vaccination, and the composite index in most countries from the first to the second survey, while inequalities were reduced. Rapid changes in overall coverage were associated with improved equity. These findings were not due to a capping effect associated with limited scope for improvement in rich households. For use of insecticide-treated bednets, coverage was high for the richest households, but countries making rapid progress did almost as well in reaching the poorest groups. National increases in coverage were primarily driven by how rapidly coverage increased in the poorest quintiles.
  
  
  CONCLUSIONS
  Equity should be accounted for when planning the scaling up of interventions and assessing national progress.
  
  
  BACKGROUND
  Bill & Melinda Gates Foundation; World Bank; Governments of Australia, Brazil, Canada, Norway, Sweden, and UK.
authors.affiliation: Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil. cvictora@gmail.com
authors.forename: Cesar G
authors.initials: CG
authors.lastname: Victora
authors.forename: Aluisio J D
authors.initials: AJ
authors.lastname: Barros
authors.forename: Henrik
authors.initials: H
authors.lastname: Axelson
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: Mickey
authors.initials: M
authors.lastname: Chopra
authors.forename: Giovanny V A
authors.initials: GV
authors.lastname: França
authors.forename: Kate
authors.initials: K
authors.lastname: Kerber
authors.forename: Betty R
authors.initials: BR
authors.lastname: Kirkwood
authors.forename: Holly
authors.initials: H
authors.lastname: Newby
authors.forename: Carine
authors.initials: C
authors.lastname: Ronsmans
authors.forename: J Ties
authors.initials: JT
authors.lastname: Boerma
mesh_terms: D002648:Child; D002662:Child Health Services / Q000639:trends*; D003906:Developing Countries; D005260:Female; D014943:Global Health; D054624:Health Status Disparities; D006306:Health Surveys; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D008427:Maternal Health Services / Q000639:trends*; D008457:Measles / Q000517:prevention & control; D008458:Measles Vaccine / Q000008:administration & dosage; D057147:Mosquito Nets / Q000706:statistics & numerical data; D036801:Parturition; D011247:Pregnancy; D012959:Socioeconomic Factors
chemical_list: D008458:Measles Vaccine