http://repub.eur.nl/res/aut/13933/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/27550/ 2010-03-01T00:00:00Z Introduction: In low- and middle-income countries (LMICs), the probability of dying in childhood is strongly related to the socio-economic position of the parents or household in which the child is born. This article reviews the evidence on the magnitude of socio-economic inequalities in childhood mortality within LMICs, discusses possible causes and highlights entry points for intervention. Sources of data: Evidence on socio-economic inequalities in childhood mortality in LMICs is mostly based on data from household surveys and demographic surveillance sites. Areas of agreement: Childhood mortality is systematically and considerably higher among lower socio-economic groups within countries. Also most proximate mortality determinants, including malnutrition, exposure to infections, maternal characteristics and health care use show worse levels among more deprived groups. The magnitude of inequality varies between countries and over time, suggesting its amenability to intervention. Reducing inequalities in childhood mortality would substantially contribute to improving population health and reaching the Millennium Development Goals (MDGs). Areas of controversy: The contribution of specific determinants, including national policies, to childhood mortality inequalities remains uncertain. What works to reduce these inequalities, in particular whether policies should be universal or targeted to the poor, is much debated. Areas timely for developing research: The increasing political attention for addressing health inequalities needs to be accompanied by more evidence on the contribution of specific determinants, and on ways to ensure that interventions reach lower socio-economic groups. http://repub.eur.nl/res/pub/36841/ 2007-12-01T00:00:00Z Background. As reducing socio-economic inequalities in health is an important public health objective, monitoring of these inequalities is an important public health task. The specific inequality measure used can influence the conclusions drawn, and there is no consensus on which measure is most meaningful. The key issue raising most debate is whether to use relative or absolute inequality measures. Our paper aims to inform this debate and develop recommendations for monitoring health inequalities on the basis of empirical analyses for a broad range of developing countries. Methods. Wealth-group specific data on under-5 mortality, immunisation coverage, antenatal and delivery care for 43 countries were obtained from the Demographic and Health Surveys. These data were used to describe the association between the overall level of these outcomes on the one hand, and relative and absolute poor-rich inequalities in these outcomes on the other. Results. We demonstrate that the values that the absolute and relative inequality measures can take are bound by mathematical ceilings. Yet, even where these ceilings do not play a role, the magnitude of inequality is correlated with the overall level of the outcome. The observed tendencies are, however, not necessities. There are countries with low mortality levels and low relative inequalities. Also absolute inequalities showed variation at most overall levels. Conclusion. Our study shows that both absolute and relative inequality measures can be meaningful for monitoring inequalities, provided that the overall level of the outcome is taken into account. Suggestions are given on how to do this. In addition, our paper presents data that can be used for benchmarking of inequalities in the field of maternal and child health in low and middle-income countries. http://repub.eur.nl/res/pub/11023/ 2007-09-05T00:00:00Z Worldwide more than 10 million children die each year before their fifth birthday (Black et al. 2003). Not only are these deaths concentrated in low and middle income countries; children of the poor and less educated within these countries too exhibit systematically higher mortality levels. Policy makers are learning that improving average population health is not enough. Monitoring and tackling inequalities in health between socio-economic groups within countries has become an increasingly important objective. Whereas research on socio-economic health inequalities is a well-established tradition in high income countries, it is only recently that such inequalities are being studied more systematically in relation to low and middle income countries as well. This has raised new issues regarding measurement and methodology, but also provides opportunities for contributing to existing debates. The first aim of this thesis is to contribute to the evaluation of measures to describe socio-economic mortality inequalities in low and middle income countries. Accurate and valid measurement of socio-economic mortality inequalities is a prerequisite for establishing the magnitude of the problem, for monitoring, and for unravelling its determinants. The second aim of this thesis is to contribute to the description and explanation of time and place variations in the magnitude of socio-economic inequalities in under-5 mortality. Not much is known about how socio-economic inequalities in under-5 mortality vary across countries or over time, and what the determinants of these variations are. Understanding why inequalities are larger in some populations than in others is a first step towards evidence based public health interventions. The availability of Demographic and Health Survey data for multiple time periods for a large set of low and middle income countries, the heterogeneity across these countries and the rapid changes that some countries are experiencing, provide a unique opportunity to contribute to the issues raised above. http://repub.eur.nl/res/pub/13257/ 2003-01-01T00:00:00Z BACKGROUND: Currently, poor-rich inequalities in health in developing countries receive a lot of attention from both researchers and policy makers. Since measuring economic status in developing countries is often problematic, different indicators of wealth are used in different studies. Until now, there is a lack of evidence on the extent to which the use of different measures of economic status affects the observed magnitude of health inequalities. METHODS: This paper provides this empirical evidence for 10 developing countries, using the Demographic and Health Surveys data-set. We compared the World Bank asset index to three alternative wealth indices, all based on household assets. Under-5 mortality and measles immunisation coverage were the health outcomes studied. Poor-rich inequalities in under-5 mortality and measles immunisation coverage were measured using the Relative Index of Inequality. RESULTS: Comparing the World Bank index to the alternative indices, we found that (1) the relative position of households in the national wealth hierarchy varied to an important extent with the asset index used, (2) observed poor-rich inequalities in under-5 mortality and immunisation coverage often changed, in some cases to an important extent, and that (3) the size and direction of this change varied per country, index, and health indicator. CONCLUSION: Researchers and policy makers should be aware that the choice of the measure of economic status influences the observed magnitude of health inequalities, and that differences in health inequalities between countries or time periods, may be an artefact of different wealth measures used.