gambia equity proﬁle - countdown...

Gambia Equity Profile

1.5% received less than 3 interven�onsMothers & Children

Wealth and area of residence Composite coverage index ‐ subna�onal coverage

Wealth Quin�les Urban | rural areas of residence

Kuntaur54.2

Wealth quin�les

Number of interven�ons

1 2 3 4 5 6 870

27%belong to

poorest quintile 20%

52%

34%

60%

50% live inrural areas

41%Brikama

region

havemothers with no education

72%

Mothers & childrenwith <3 interven�ons X All mothers & children

Source: DHS 2013 (Analyses based on the most recent publicly available survey)

%

0

20

40

60

80

100

Q1Poorest

Q2 Q3 Q4 Q5Richest

Demand for family planningsa�sfied with modern methods

rural

urban

Skilled a�endant at delivery

rural

urban

Immuniza�on ‐ DPT3

rural

urbanImproved sourceof drinking water

rural

urban

Coverage (%)0 20 40 60 80 100

0 20 40 60 80 100

0 20 40 60 80 100 0 20 40 60 80 100

Q1 Poorest Q2 Q3 Q4 Q5 Richest


Antenatal care (4 or more visits)

Neonatal tetanus protec�on


Postnatal care for mothers

Postnatal care for babies

Immuniza�on ‐ Rota


Immuniza�on ‐ Measles

Diarrhoea treatment: ORS

Early ini�a�on of breas�eeding

Exclusive breas�eeding

Con�nued breas�eeding (1 year)

Vitamin A supplementa�on

Careseeking for symptomsof pneumonia

• antenatal care (4+ visits) • tetanus toxoid during pregnancy• skilled a�endant at delivery • child received vitamin A supplementa�on • BCG (tuberculosis) vaccina�on • DPT3 (diphtheria–tetanus–pertussis)

vaccina�on • measles vaccina�on • improved drinking water source


Urban Rural

Coverage (%)


Coverage (%) Coverage (%)

Coverage of essen�al RMNCH interven�ons Co‐coverage of essen�al interven�ons


Antenatal care (4 or more visits)

Neonatal tetanus protec�on


Postnatal care for mothers

Postnatal care for babies

Immuniza�on ‐ Rota


Immuniza�on ‐ Measles

Careseeking for symptomsof pneumonia

Diarrhoea treatment: ORS

Early ini�a�on of breas�eeding

Exclusive breas�eeding

Con�nued breas�eeding (1 year)

Vitamin A supplementa�on

Indicators Na�onal

Wealth quin�lesWealth‐related

equity indicatorsWoman's educa�on Child's sex

Area ofresidence

Q1 Q2 Q3 Q4 Q5Ra�o

Q5/Q1Difference

Q5‐Q1CIX SII None Primary Secondary+ Male Female Rural Urban


23.8 14.6 14.9 17.7 29.3 37.7 2.6 23.2 21.2 31.1 17.9 18.3 36.9 ‐ ‐ 14.5 31.6

Antenatal care (4 or more visits) 76.7 74.3 77.8 74.1 76.1 81.9 1.1 7.5 1.4 5.7 75.6 77.4 78.6 77.8 75.6 77.9 75.4

Neonatal tetanus protec�on 41.5 42.9 43.0 40.3 40.8 40.7 0.9 ‐2.2 ‐1.3 ‐3.2 41.2 40.5 42.7 43.0 40.0 43.2 39.9

Skilled a�endant at delivery 57.8 47.5 47.2 49.1 68.5 81.8 1.7 34.3 12.1 40.9 49.1 60.7 75.0 59.0 56.6 42.1 75.4

Postnatal care for mothers 76.0 72.3 69.0 73.6 80.1 88.7 1.2 16.4 4.4 20.3 71.1 77.3 85.7 75.9 76.2 68.7 84.6

Postnatal care for babies 5.7 7.7 6.4 4.5 6.4 3.1 0.4 ‐4.6 ‐12.6 ‐4.2 5.3 7.7 5.6 5.6 5.9 7.0 4.2

Immuniza�on ‐ Rota ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Immuniza�on ‐ DPT3 89.4 91.3 89.5 90.6 89.7 85.6 0.9 ‐5.7 ‐1.1 ‐5.0 91.4 86.4 87.2 91.2 87.6 92.4 86.0

Immuniza�on ‐ Measles 87.8 93.0 89.4 89.3 89.4 76.2 0.8 ‐16.8 ‐2.9 ‐15.2 89.1 92.5 82.9 87.6 88.1 92.9 82.0

Careseeking forsymptoms of pneumonia

68.0 69.7 70.1 70.8 62.4 67.3 1.0 ‐2.4 ‐1.2 ‐6.0 71.4 55.2 69.6 72.0 62.5 68.0 68.1

Diarrhoea treatment: ORS 59.2 55.8 56.8 60.7 64.4 57.9 1.0 2.1 1.6 5.9 60.6 63.5 53.7 59.2 59.1 56.8 61.5

Early ini�a�on of breas�eeding 51.5 54.8 54.0 55.6 48.3 42.6 0.8 ‐12.2 ‐4.5 ‐13.4 55.1 46.8 46.6 51.4 51.6 55.2 47.2

Exclusive breas�eeding 46.8 53.6 54.5 43.4 38.5 43.5 0.8 ‐10.1 ‐7.3 ‐19.0 45.2 49.0 48.2 44.3 48.8 51.7 41.2

Con�nued breas�eeding (1 year) 97.8 96.9 97.6 100.0 98.9 95.2 1.0 ‐1.8 0.1 ‐0.4 98.1 100.0 96.1 97.5 98.2 98.1 97.5

Vitamin A supplementa�on 68.7 69.4 70.9 69.5 65.8 67.4 1.0 ‐1.9 ‐1.1 ‐4.4 68.6 66.6 70.0 68.1 69.3 71.5 65.7



Indicators Banjul Kanifing Brikama Mansakonko Kerewan Kuntaur Janjanbureh Basse


43.8 33.1 27.8 24.6 18.7 14.7 13.3 4.6

Antenatal care (4 or more visits) 82.8 81.5 74.4 79.1 71.4 71.8 84.1 77.2

Neonatal tetanus protec�on 39.6 37.9 38.9 52.9 40.4 48.3 53.9 39.5

Skilled a�endant at delivery 89.4 85.2 69.4 57.3 44.0 34.3 35.5 32.9

Postnatal care for mothers 83.9 83.3 82.8 77.0 60.9 61.3 76.9 70.9

Postnatal care for babies 4.3 4.1 6.6 14.2 6.3 3.7 6.7 3.0

Immuniza�on ‐ Rota ‐ ‐ ‐ ‐ ‐ ‐ ‐ ‐

Immuniza�on ‐ DPT3 78.6 84.2 87.7 94.5 91.4 91.1 85.7 97.6

Immuniza�on ‐ Measles 81.8 84.3 82.9 92.4 93.3 94.5 86.8 95.1

Careseeking forsymptoms of pneumonia

54.6 68.6 69.8 ‐ 71.2 54.6 66.6 ‐

Diarrhoea treatment: ORS 60.5 57.2 62.3 57.9 63.9 55.0 59.0 52.0

Early ini�a�on of breas�eeding 40.6 45.6 44.8 56.8 50.7 51.3 60.2 66.9

Exclusive breas�eeding 45.5 41.1 45.5 60.1 42.5 38.2 49.2 56.1

Con�nued breas�eeding (1 year) 83.4 98.0 97.3 100.0 100.0 98.5 95.6 98.6

Vitamin A supplementa�on 72.1 69.9 66.8 76.6 70.8 79.1 74.9 58.8



Indicator coverage by country region



• Demand for family planning sa�sfied with modern methods: percentage of women in union using modern contracep�ves among those who are fer�le and do not want a child in the next two years, at least.

• Antenatal care, 4 or more visits: percentage of women who had at least 4 visits of antenatal care during pregnancy.

• Neonatal tetanus protec�on: percentage of women who received tetanus injec�ons during pregnancy.

• Skilled a�endant at delivery: percentage of women who had delivery a�ended by a doctor, a nurse, or an auxiliary nurse or trained midwife. The specific �tles and cadres can vary between countries.

• Postnatal care for mothers and for babies: percentage of mothers and babies who went through a health check within 48 hours a�er the delivery.

• Immuniza�on for rotavirus, DPT3 and measles:percentage of children aged 12 to 23 months who received these vaccines.

Interven�ons and inequality measures Combined coverage indicators

Interpre�ng the graphs

To monitor progress towards the Sustainable Development Goals, it is essen�al to monitor the coverage of health interven�ons in subgroups of the popula�on because na�onal averages can hide important inequali�es. Here, we selected 15 interven�ons represen�ng the con�nuum of care of reproduc�ve, maternal, neonatal and child health (RMNCH) to show how countries are faring in terms of coverage by regions of the country, wealth quin�les (5 equal sized groups), urban or rural area of residence and both wealth and area. In the table presented in page 2, we also present results by woman's educa�on and child's sex.

We also present simple measures of wealth inequality (difference and ra�o) and complex measures. These are the slope index of inequality (SII), for absolute inequality, and the concentra�on index (CIX), for rela�ve inequality. The SII can be interpreted as the difference in coverage between the two extremes of the wealth distribu�on. The CIX is similar to the Gini index and gives an idea of how concentrated the coverage of each indicator is, towards the rich (posi�ve value) or the poor (nega�ve value). The CIX can vary from zero (no inequality) to 100 (maximum concentra�on), but in prac�ce values above 30 already represent a fairly high level of inequality.

A short descrip�on of the interven�ons is presented below. The full defini�on of the interven�ons tracked by Countdown can be found in the annexes of the main report.

• Careseeking for pneumonia: percentage of children who presented symptoms of pneumonia and were taken to a health facility.

• Treatment for diarrhea with ORS: percentage of children with diarrhea who received oral rehydra�on salts.

• Early ini�a�on of breas�eeding: percentage of children who were put to the breast in the first hour of life.

• Exclusive breas�eeding: percentage of children less than six months of age who are being exclusively breas�ed (receiving only breastmilk, not even water or tea).

• Con�nued breas�eeding at one year: percentage of children aged 12 to 15 months of age who are s�ll being breas�ed.

• Vitamin A supplementa�on: percentage of children who received vitamin A in the six months preceding the interview (in countries where there is a supplementa�on program).

Composite coverage index – CCIWe present a map of each country with the CCI by region. The CCI is a neat way to summarize coverage by health interven�ons using a single number, in place of several of them. It is calculated as the weighted mean of eight selected interven�ons – demand for family planning sa�sfied, antenatal care (4+ visits), skilled a�endant at delivery, BCG, DPT3 and measles vaccines, and finally careseeking for pneumonia and ORS for diarrhea.

Co‐coverageCo‐coverage is a count of how many, out of 7 or 8 interven�ons offered in the country, the pair of mother and child received. Ideally, they will receive all interven�ons available, but in prac�ce we observe very different situa�ons. The interven�ons considered here are antenatal care (4+ visits), tetanus toxoid during pregnancy, skilled a�endant at delivery, BCG, DPT3 and measles vaccines, vitamin A supplementa�on and improved source of drinking water. The count goes from zero, to the maximum of 7 or 8 interven�ons, depending on the country.

In the equiplots, the graphs with aligned dots, each dot represents the coverage of a given interven�on for a subgroup. It can be area or residence, or wealth quin�les (the first quin�le includes the poorest 20% of the sample, and so on). The quin�les are labelled Q1 to Q5. The distance between the dots is the difference in coverage between the relevant groups. The larger the difference, the bigger the absolute inequali�es in the country. Ideally, in this type of graph, we would like to see all the dots close together on the right side, where coverage approaches 100%.

The map shows the regions of each country, and CCI coverage using colors to highlight differences across the regions. The darker the color, the higher the coverage. The actual values (%) are presented below the names of the regions. At the bo�om, we also present an equiplot of the CCI by wealth quin�les. Not to be confused with a map scale!

Co‐coverage is presented in two ways. The top graph displays how many mothers and children in each of the five wealth quin�les receive zero, one, two, up to eight of the interven�ons included in the co‐coverage measure. We typically see that the high‐count sec�ons increase and are much bigger towards the richer quin�les. The bo�om sec�on shows differences in key characteris�cs of mothers and children that received less than 3 of these interven�ons in comparison to all mothers and children living in the country. Comparisons presented include likelihood to belong to the poorest quin�le, to live in rural areas or specific geographical regions, and for the mother to have received no educa�on. For instance, compared to the 20% of the mothers and children in the poorest quin�le, we o�en see that a much higher propor�on (30‐40%) of those receiving less than three interven�ons belong to that quin�le.

gambia equity proﬁle - countdown...

Documents