Is Health Aid Reaching the Poor? Analysis of Household Data from Aid Recipient Countries
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Auteurs : Eran Bendavid [États-Unis]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
To determine the extent to which the narrowing of child mortality across wealth gradients has been related to foreign aid to the health sector in low- and middle-income countries.
Mortality and wealth data on 989,901 under-5 children from 957,674 households in 49 aid recipient countries in Africa, Asia, South America, and the Caribbean between 1993 and 2012 were used in the analysis. Declines in under-5 mortality in the four poorest wealth quantiles were compared to the decline among the wealthiest at varying levels of health aid per capita using fixed effects multivariable regression models and controlling for maternal education, urbanization, and domestic spending on health among recipient countries.
Each additional dollar in total health aid per capita was associated with 5.7 fewer deaths per 10,000 child-years among children in the poorest relative to the wealthiest households (p<0.001). This was also true when measured in percent declines (1.90% faster decline in under-5 mortality among the poorest compared with the wealthiest with each dollar in total health aid, p = 0.008). The association was stronger when using health aid specifically for malaria than total health aid, 12.60% faster decline among the poorest compared with the wealthiest with each dollar in malaria aid, p = 0.001.
Foreign aid to the health sector is preferentially related to reductions in under-5 mortality among the poorest compared with the wealthiest. Health aid addressing malaria, which imposes a disproportionate burden among the poor, may explain the observed effect.
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DOI: 10.1371/journal.pone.0084025
PubMed: 24404148
PubMed Central: 3880283
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Analysis of Household Data from Aid Recipient Countries</title><author><name sortKey="Bendavid, Eran" sort="Bendavid, Eran" uniqKey="Bendavid E" first="Eran" last="Bendavid">Eran Bendavid</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Division of General Medical Disciplines, Stanford University, Stanford, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of General Medical Disciplines, Stanford University, Stanford, California</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24404148</idno><idno type="pmc">3880283</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880283</idno><idno type="RBID">PMC:3880283</idno><idno type="doi">10.1371/journal.pone.0084025</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002A76</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002A76</idno><idno type="wicri:Area/Pmc/Curation">002A75</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">002A75</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Is Health Aid Reaching the Poor? Analysis of Household Data from Aid Recipient Countries</title><author><name sortKey="Bendavid, Eran" sort="Bendavid, Eran" uniqKey="Bendavid E" first="Eran" last="Bendavid">Eran Bendavid</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Division of General Medical Disciplines, Stanford University, Stanford, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Division of General Medical Disciplines, Stanford University, Stanford, California</wicri:regionArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California</wicri:regionArea></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>To determine the extent to which the narrowing of child mortality across wealth gradients has been related to foreign aid to the health sector in low- and middle-income countries.</p></sec><sec><title>Methods</title><p>Mortality and wealth data on 989,901 under-5 children from 957,674 households in 49 aid recipient countries in Africa, Asia, South America, and the Caribbean between 1993 and 2012 were used in the analysis. Declines in under-5 mortality in the four poorest wealth quantiles were compared to the decline among the wealthiest at varying levels of health aid per capita using fixed effects multivariable regression models and controlling for maternal education, urbanization, and domestic spending on health among recipient countries.</p></sec><sec><title>Results</title><p>Each additional dollar in total health aid per capita was associated with 5.7 fewer deaths per 10,000 child-years among children in the poorest relative to the wealthiest households (p<0.001). This was also true when measured in percent declines (1.90% faster decline in under-5 mortality among the poorest compared with the wealthiest with each dollar in total health aid, p = 0.008). The association was stronger when using health aid specifically for malaria than total health aid, 12.60% faster decline among the poorest compared with the wealthiest with each dollar in malaria aid, p = 0.001.</p></sec><sec><title>Conclusions</title><p>Foreign aid to the health sector is preferentially related to reductions in under-5 mortality among the poorest compared with the wealthiest. Health aid addressing malaria, which imposes a disproportionate burden among the poor, may explain the observed effect.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ravishankar, N" uniqKey="Ravishankar N">N Ravishankar</name></author><author><name sortKey="Gubbins, P" uniqKey="Gubbins P">P Gubbins</name></author><author><name sortKey="Cooley, Rj" uniqKey="Cooley R">RJ Cooley</name></author><author><name sortKey="Leach Kemon, K" uniqKey="Leach Kemon K">K Leach-Kemon</name></author><author><name sortKey="Michaud, Cm" uniqKey="Michaud C">CM Michaud</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sridhar, D" uniqKey="Sridhar D">D Sridhar</name></author><author><name sortKey="Batniji, R" uniqKey="Batniji R">R Batniji</name></author></analytic></biblStruct><biblStruct><analytic><author><name 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sortKey="Otten, Mw" uniqKey="Otten M">MW Otten</name></author><author><name sortKey="Menon, M" uniqKey="Menon M">M Menon</name></author><author><name sortKey="Cibulskis, Re" uniqKey="Cibulskis R">RE Cibulskis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lim, Ss" uniqKey="Lim S">SS Lim</name></author><author><name sortKey="Fullman, N" uniqKey="Fullman N">N Fullman</name></author><author><name sortKey="Stokes, A" uniqKey="Stokes A">A Stokes</name></author><author><name sortKey="Ravishankar, N" uniqKey="Ravishankar N">N Ravishankar</name></author><author><name sortKey="Masiye, F" uniqKey="Masiye F">F Masiye</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Glass, Ri" uniqKey="Glass R">RI Glass</name></author><author><name sortKey="Parashar, Ud" uniqKey="Parashar U">UD Parashar</name></author><author><name sortKey="Bresee, Js" uniqKey="Bresee J">JS Bresee</name></author><author><name sortKey="Turcios, R" uniqKey="Turcios R">R Turcios</name></author><author><name sortKey="Fischer, Tk" uniqKey="Fischer T">TK Fischer</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Easterly, W" uniqKey="Easterly W">W Easterly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cometto, G" uniqKey="Cometto G">G Cometto</name></author><author><name sortKey="Ooms, G" uniqKey="Ooms G">G Ooms</name></author><author><name sortKey="Starrs, A" uniqKey="Starrs A">A Starrs</name></author><author><name sortKey="Zeitz, P" uniqKey="Zeitz P">P Zeitz</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mudenda, D" uniqKey="Mudenda D">D Mudenda</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Garrett, L" uniqKey="Garrett L">L Garrett</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Black, Re" uniqKey="Black R">RE Black</name></author><author><name sortKey="Cousens, S" uniqKey="Cousens S">S Cousens</name></author><author><name sortKey="Johnson, Hl" uniqKey="Johnson H">HL Johnson</name></author><author><name sortKey="Lawn, Je" uniqKey="Lawn J">JE Lawn</name></author><author><name sortKey="Rudan, I" uniqKey="Rudan I">I Rudan</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24404148</article-id><article-id pub-id-type="pmc">3880283</article-id><article-id pub-id-type="publisher-id">PONE-D-13-42508</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0084025</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine</subject><subj-group><subject>Epidemiology</subject><subj-group><subject>Social Epidemiology</subject></subj-group></subj-group><subj-group><subject>Global Health</subject></subj-group><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Parasitic Diseases</subject><subj-group><subject>Malaria</subject></subj-group></subj-group></subj-group><subj-group><subject>Non-Clinical Medicine</subject><subj-group><subject>Health Care Policy</subject><subj-group><subject>Child and Adolescent Health Policy</subject></subj-group></subj-group><subj-group><subject>Health Economics</subject><subject>Socioeconomic Aspects of Health</subject></subj-group></subj-group><subj-group><subject>Public Health</subject><subj-group><subject>Child Health</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Is Health Aid Reaching the Poor? Analysis of Household Data from Aid Recipient Countries</article-title><alt-title alt-title-type="running-head">Health Aid and Child Mortality among the Poor</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Bendavid</surname><given-names>Eran</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Division of General Medical Disciplines, Stanford University, Stanford, California, United States of America</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Shiff</surname><given-names>Clive</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Johns Hopkins University, United States of America</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>ebd@stanford.edu</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The author has declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: EB. Performed the experiments: EB. Analyzed the data: EB. Wrote the paper: EB.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>3</day><month>1</month><year>2014</year></pub-date><volume>9</volume><issue>1</issue><elocation-id>e84025</elocation-id><history><date date-type="received"><day>16</day><month>10</month><year>2013</year></date><date date-type="accepted"><day>19</day><month>11</month><year>2013</year></date></history><permissions><copyright-year>2014</copyright-year><copyright-holder>Eran Bendavid</copyright-holder><license xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Objective</title><p>To determine the extent to which the narrowing of child mortality across wealth gradients has been related to foreign aid to the health sector in low- and middle-income countries.</p></sec><sec><title>Methods</title><p>Mortality and wealth data on 989,901 under-5 children from 957,674 households in 49 aid recipient countries in Africa, Asia, South America, and the Caribbean between 1993 and 2012 were used in the analysis. Declines in under-5 mortality in the four poorest wealth quantiles were compared to the decline among the wealthiest at varying levels of health aid per capita using fixed effects multivariable regression models and controlling for maternal education, urbanization, and domestic spending on health among recipient countries.</p></sec><sec><title>Results</title><p>Each additional dollar in total health aid per capita was associated with 5.7 fewer deaths per 10,000 child-years among children in the poorest relative to the wealthiest households (p<0.001). This was also true when measured in percent declines (1.90% faster decline in under-5 mortality among the poorest compared with the wealthiest with each dollar in total health aid, p = 0.008). The association was stronger when using health aid specifically for malaria than total health aid, 12.60% faster decline among the poorest compared with the wealthiest with each dollar in malaria aid, p = 0.001.</p></sec><sec><title>Conclusions</title><p>Foreign aid to the health sector is preferentially related to reductions in under-5 mortality among the poorest compared with the wealthiest. Health aid addressing malaria, which imposes a disproportionate burden among the poor, may explain the observed effect.</p></sec></abstract><funding-group><funding-statement>Financial support for this study was received from the George Rosenkranz award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="9"></page-count></counts></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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