title: Finding the gap: revealing local disparities in coverage of maternal, newborn and child health services in South Sudan using lot quality assurance sampling.
abstract: OBJECTIVE
  We adapted a rapid monitoring method to South Sudan, a new nation with one of the world's highest maternal and child mortality rates, aiming to assess coverage of maternal, neonatal and child health (MNCH) services at the time of independence, and introducing a monitoring and evaluation system (M&E) for equity-sensitive tracking of progress related to Millennium Development Goals (MDG) 4 and 5 at national, state and county levels to detect local variability.
  
  
  METHODS
  We conducted a national cross-sectional household survey among women from six client populations in all, but six of South Sudan's 79 counties. We used lot quality assurance sampling (LQAS) to measure coverage with diverse MNCH indicators to obtain information for national-, state- and county-level health system management decision-making.
  
  
  RESULTS
  National coverage of MNCH services was low for all maternal and neonatal care, child immunisation, and child care indicators. However, results varied across states and counties. Central Equatoria State (CES), where the capital is located, showed the highest coverage for most indicators (e.g. ≥4 antenatal care visits range: 4.5% in Jonglei to 40.1% in CES). Urban counties often outperformed rural ones.
  
  
  CONCLUSIONS
  This adaptation of LQAS to South Sudan demonstrates how it can be used in the future as an M&E system to track progress of MDGs at national, state and county levels to detect local disparities. Overall, our data reveal a desperate need for improving MNCH service coverage in all states.
authors.affiliation: Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Valadez
authors.affiliation: Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK.
authors.forename: Sima
authors.initials: S
authors.lastname: Berendes
authors.affiliation: Ministry of Health of the Republic of South Sudan, Directorate of Policy, Planning, Budgeting and Research, Juba, South Sudan.
authors.forename: Richard
authors.initials: R
authors.lastname: Lako
authors.affiliation: Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Gould
authors.affiliation: Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK.
authors.forename: William
authors.initials: W
authors.lastname: Vargas
authors.affiliation: Liverpool School of Tropical Medicine, International Public Health Department, Liverpool, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Milner
mesh_terms: D000328:Adult; D002648:Child; D000067576:Child Health; D002662:Child Health Services / Q000592:standards; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D000068104:Infant Health; D007231:Infant, Newborn; D055810:Lot Quality Assurance Sampling / Q000379:methods; D000068097:Maternal Health; D000068101:Maternal-Child Health Services / Q000592:standards*; D009026:Mortality; D011247:Pregnancy; D011785:Quality Assurance, Health Care; D012959:Socioeconomic Factors; D000068037:South Sudan / Q000453:epidemiology; D055815:Young Adult
keywords: Africa; South Sudan; equity; household survey; lot quality assurance sampling; millennium development goals; monitoring and evaluation; universal health coverage