title: Identifying inequities in maternal and child health through risk stratification to inform health systems strengthening in Northern Togo.
abstract: OBJECTIVE
  In Togo, substantial progress in maternal and child health is needed to reach global development goals. To better inform clinic and community-based health services, this study identifies factors associated with maternal and child health care utilization in the Kara region of Northern Togo.
  
  
  METHODS
  We conducted a population-representative household survey of four health clinic catchment areas of 1,075 women of reproductive age in 2015. Multivariable logistic regression was used to model individual and structural factors associated with utilization of four maternal and child health services. Key outcomes were: facility-based delivery, maternal postnatal health check by a health professional within the first six weeks of birth, childhood vaccination, and receipt of malaria medication for febrile children under age five within 72 hours of symptom onset.
  
  
  RESULTS
  83 percent of women who gave birth in the last 2 years delivered at a health facility. In adjusted models, the strongest predictor of facility delivery in the rural catchment areas was proximity to a health center, with women living under three kilometers having 3.7 (95% CI 1.7, 7.9) times the odds of a facility birth. Only 11 percent of women received a health check by a health provider at any time in the postnatal period. Postnatal health checks were less likely for women in the poorest households and for women who resided in rural areas. Children of polygamous mothers had half the odds of receiving malaria medication for fever within 72 hours of symptom onset, while children with increased household wealth status had increased odds of childhood vaccination and receiving treatment for malaria.
  
  
  CONCLUSIONS
  Our analysis highlights the importance of risk stratification analysis to inform the delivery and scope of maternal and child health programs needed to reach those with the least access to care.
authors.affiliation: Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America.|Population Council, New York, New York, United States of America.
authors.forename: Katharine J
authors.initials: KJ
authors.lastname: McCarthy
authors.affiliation: Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, United States of America.|Department of Family and Social Medicine, Montefiore Medical Center, Bronx, New York, United States of America.
authors.forename: Sandra
authors.initials: S
authors.lastname: Braganza
authors.affiliation: Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York, United States of America.|Department of Family and Social Medicine, Montefiore Medical Center, Bronx, New York, United States of America.|Hope Through Health, Kara, Togo, New York, New York, United States of America.
authors.forename: Kevin
authors.initials: K
authors.lastname: Fiori
authors.affiliation: Hope Through Health, Kara, Togo, New York, New York, United States of America.
authors.forename: Christophe
authors.initials: C
authors.lastname: Gbeleou
authors.affiliation: Kozah District Health Department, Ministry of Health, Kara, Togo.
authors.forename: Vivien
authors.initials: V
authors.lastname: Kpakpo
authors.affiliation: Hope Through Health, Kara, Togo, New York, New York, United States of America.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lopez
authors.affiliation: Hope Through Health, Kara, Togo, New York, New York, United States of America.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schechter
authors.affiliation: Hope Through Health, Kara, Togo, New York, New York, United States of America.
authors.forename: Alicia
authors.initials: A
authors.lastname: Singham Goodwin
authors.affiliation: Graduate School of Public Health and Health Policy, City University of New York, New York, United States of America.
authors.forename: Heidi E
authors.initials: HE
authors.lastname: Jones
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D000067576:Child Health; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D000068097:Maternal Health; D008875:Middle Aged; D011247:Pregnancy; D014037:Togo; D055815:Young Adult