Geographic inequalities in health intervention coverage - mapping the composite coverage index in Peru using geospatial modelling. 2022

Leonardo Z Ferreira, and C Edson Utazi, and Luis Huicho, and Kristine Nilsen, and Fernando P Hartwig, and Andrew J Tatem, and Aluisio J D Barros
International Center for Equity in Health, Universidade Federal de Pelotas, R. Marechal Deodoro, Centro, Pelotas, 1160, Brazil. lferreira@equidade.org.

The composite coverage index (CCI) provides an integrated perspective towards universal health coverage in the context of reproductive, maternal, newborn and child health. Given the sample design of most household surveys does not provide coverage estimates below the first administrative level, approaches for achieving more granular estimates are needed. We used a model-based geostatistical approach to estimate the CCI at multiple resolutions in Peru. We generated estimates for the eight indicators on which the CCI is based for the departments, provinces, and areas of 5 × 5 km of Peru using data from two national household surveys carried out in 2018 and 2019 plus geospatial covariates. Bayesian geostatistical models were fit using the INLA-SPDE approach. We assessed model fit using cross-validation at the survey cluster level and by comparing modelled and direct survey estimates at the department-level. CCI coverage in the provinces along the coast was consistently higher than in the remainder of the country. Jungle areas in the north and east presented the lowest coverage levels and the largest gaps between and within provinces. The greatest inequalities were found, unsurprisingly, in the largest provinces where populations are scattered in jungle territory and are difficult to reach. Our study highlighted provinces with high levels of inequality in CCI coverage indicating areas, mostly low-populated jungle areas, where more attention is needed. We also uncovered other areas, such as the border with Bolivia, where coverage is lower than the coastal provinces and should receive increased efforts. More generally, our results make the case for high-resolution estimates to unveil geographic inequities otherwise hidden by the usual levels of survey representativeness.

UI MeSH Term Description Entries
D007231 Infant, Newborn An infant during the first 28 days after birth. Neonate,Newborns,Infants, Newborn,Neonates,Newborn,Newborn Infant,Newborn Infants
D010568 Peru A country in western South America, bordering the South Pacific Ocean, and located between Chile and Ecuador.
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002662 Child Health Services Organized services to provide health care for children. Infant Health Services,Child Services, Health,Health Services, Child,Health Services, Infant,Infant Services, Health,Services, Child Health,Services, Infant Health,Child Health Service,Health Service, Child,Health Service, Infant,Infant Health Service,Service, Child Health,Service, Infant Health
D005191 Family Characteristics Size and composition of the family. Family Size,Couples,Family Demography,Family Life Surveys,Family Size, Average,Family Size, Completed,Family Size, Desired,Family Size, Expected,Family Size, Ideal,Family and Household,Generations,Head of Household,Households,One-Person Household,Average Family Size,Average Family Sizes,Completed Family Size,Completed Family Sizes,Demography, Family,Desired Family Size,Desired Family Sizes,Expected Family Size,Expected Family Sizes,Family Characteristic,Family Demographies,Family Life Survey,Family Sizes,Family Sizes, Ideal,Household,Household Head,Household Heads,Household and Family,Household, One-Person,Ideal Family Size,Ideal Family Sizes,One Person Household,One-Person Households,Survey, Family Life
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000067576 Child Health The concept covering the physical and mental conditions of CHILDREN. Child Wellbeing,Child Well Being,Child Well-Being,Children's Health,Childrens Health,Health, Child,Health, Children's,Health, Childrens,Well Being, Child,Well-Being, Child,Wellbeing, Child
D001499 Bayes Theorem A theorem in probability theory named for Thomas Bayes (1702-1761). In epidemiology, it is used to obtain the probability of disease in a group of people with some characteristic on the basis of the overall rate of that disease and of the likelihood of that characteristic in healthy and diseased individuals. The most familiar application is in clinical decision analysis where it is used for estimating the probability of a particular diagnosis given the appearance of some symptoms or test result. Bayesian Analysis,Bayesian Estimation,Bayesian Forecast,Bayesian Method,Bayesian Prediction,Analysis, Bayesian,Bayesian Approach,Approach, Bayesian,Approachs, Bayesian,Bayesian Approachs,Estimation, Bayesian,Forecast, Bayesian,Method, Bayesian,Prediction, Bayesian,Theorem, Bayes

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