Malaria Prevention for Pregnant Women and Under-Five Children in 10 Sub-Saharan Africa Countries: Socioeconomic and Temporal Inequality Analysis

Denis Okova (), Akim Tafadzwa Lukwa, Robinson Oyando, Paidamoyo Bodzo, Plaxcedes Chiwire and Olufunke A. Alaba
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Denis Okova: Health Economics Unit, School of Public Health, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa
Akim Tafadzwa Lukwa: Health Economics Unit, School of Public Health, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa
Robinson Oyando: Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi P.O. Box 43640-00100, Kenya
Paidamoyo Bodzo: Health Economics Unit, School of Public Health, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa
Plaxcedes Chiwire: Western Cape Department: Health, Western Cape Province, P.O. Box 2060, Cape Town 8000, South Africa
Olufunke A. Alaba: Health Economics Unit, School of Public Health, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, South Africa

IJERPH, 2024, vol. 21, issue 12, 1-25

Abstract: Background: Malaria remains a public health challenge in low- and middle-income countries (LMICs). Despite gains from strategies like Insecticide-Treated Nets (ITNs) and Intermittent Preventive Treatment during pregnancy (IPTp), significant socioeconomic inequalities persist, particularly among pregnant women and children under five. This study analyzed temporal and socioeconomic inequalities in malaria prevention in sub-Saharan Africa (SSA). Methods: Nationally representative Demographic Health Surveys from 10 SSA countries (Mozambique, Burkina Faso, Tanzania, Côte d’Ivoire, Madagascar Kenya, Rwanda, Nigeria, Uganda, and Cameroon) were used, comparing two time periods. Changes in ITN use by pregnant women and children under five, as well as IPTp coverage, were assessed. Inequalities based on socioeconomic status (SES) and residence were analyzed using the Erreygers Normalized Concentration Index and Theil index. Results: The results revealed significant variability in ITN use and IPTp coverage within countries. Eight countries showed improvements in ITN use during pregnancy, with Nigeria seeing a 173.9% increase over five years. Burkina Faso and Tanzania consistently reported high ITN use (~87%) in children under five. IPTp coverage increased in all countries except Kenya. Decomposition using the Theil index indicated that within-group inequalities, particularly based on SES and residence, were the primary drivers of disparities. Conclusions: To ensure progress toward universal health coverage, malaria prevention programs must prioritize vulnerable populations and be continuously evaluated.

Keywords: child health; health equity; Insecticide Treated Nets (ITNs); Intermittent Preventive Treatment (IPTp); maternal health; socioeconomic disparities (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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