Trends in Maternal and Child Health Care Utilization and Child Health Outcomes among Slum Residents in Sub-Saharan Africa and South Asia: Estimating Spatial Inequality Using a Slum Index

Purpose With rising rates of urbanization and vast growth of slums in developing countries, research is needed to measure the determinants of health and health outcomes among urban slum residents. Estimating trends in urban... [ view full abstract ]

Purpose
With rising rates of urbanization and vast growth of slums in developing countries, research is needed to measure the determinants of health and health outcomes among urban slum residents. Estimating trends in urban health among slum residents relative to other urban inhabitants provides evidence of health disparities for priority setting by program implementers and policy-makers. This study adapts Günther and Harttgen 2012’s spatial inequality approach for identifying slum residents from existing cross-sectional household data, in order to compare maternal and child health care utilization and childhood outcomes between rural, urban slum and urban non-slum residents in sub-Saharan Africa and South Asia over time.

Methods
We analyzed Demographic and Health Survey data from seven countries between 2003 and 2011. We studied four measures of maternal and child health care utilization, including: appropriate antenatal care, appropriate tetanus toxoid vaccination, skilled delivery, and full childhood immunization. Health outcomes studied include the prevalence of diarrheal disease and of acute respiratory infection in children under-five. Adjusted multivariate logistic regression models were used to assess differences in health care utilization and health outcomes between slum residents and other urban residents within each of the countries. We employed post-estimation commands to assess whether changes were significant over time.

Conclusion
In some locations, improvements over time in maternal and child health care utilization and child health outcomes among slum dwellers were found, suggesting encouraging shifts in reaching marginalized populations. However, in spite of improvements in some indicators, we also find evidence of increasing disparities in urban settings, in support of the concept of a growing “urban penalty.” Further investigation is needed to understand what factors contribute the most to improvements, ways to scale-up existing efforts, and to what extent lessons learned can be shared across countries.