2003年-世界发展银行全球_Morocco_Inequalities_in_Health_Nutrition_and_Population_60页_484kb

Summary of Morocco's Inequalities in Health, Nutrition, and Population

Core Content

This document provides an analysis of health, nutrition, and population inequalities in Morocco, focusing on how these disparities affect disadvantaged groups and the potential for targeted interventions to address them. It is part of the World Bank's Health, Nutrition, and Population (HNP) Discussion Paper series, which aims to publish preliminary findings to encourage policy discussion and debate.

Main Points

• Inequality Focus: The paper highlights the significant disparities in health, nutrition, and population outcomes across different socioeconomic groups, particularly in relation to wealth quintiles.
• Data Source: The data is derived from the Morocco version of Socio-Economic Differences in Health, Nutrition and Population (Gwatkin et al., 2000), which uses data from the Demographic and Health Surveys (DHS).
• Key Indicators: The study uses a range of indicators, including maternal and child health, nutrition status, immunization coverage, and the use of health services, to assess inequalities.
• Targeted Interventions: The paper emphasizes the importance of evidence-based interventions that focus on the poorest segments of society to achieve the Millennium Development Goals (MDGs) more effectively.
• Socioeconomic Disparities: Inequalities are most pronounced in maternal and child health services, with the poorest quintiles significantly underrepresented in access to and utilization of these services.

Key Information

Maternal Nutrition and Reproductive Health

• Body Mass Index (BMI): The prevalence of low BMI among mothers is highest in the poorest quintile (39.2%) and lowest in the richest (8.1%), with a poor-rich ratio of 4.8.
• Fertility and Contraception: The Total Fertility Rate (TFR) is 4, and it decreases with wealth. Contraceptive use is low in the poorest quintile (35.5%) and increases with wealth, with a rich-poor ratio of 2.6.
• Antenatal Care (ANC): Only 32.2% of women receive ANC, with a rich-poor ratio of 9.3 for trained medical personnel and 11.8 for doctors. The poorest quintile is 9.3 times less likely to receive ANC.
• Delivery Care: Skilled attendance at delivery is very low overall (30.8%), with only 0.7% of the poorest women receiving it. The rich-poor ratio is 15.3, and the poorest quintile is 32.7 times less likely to have skilled delivery care.
• Infant Mortality Rates (IMR): The IMR is highest in the poorest quintile (79.7 per 1,000 births) and lowest in the richest (35.1 per 1,000 births), with a poor-rich ratio of 2.3. The U5MR also shows a significant gap, with a ratio of 2.8.
• Immunization Coverage: Immunization rates are high in the richest quintile (99%) but low in the poorest (50%). The rich-poor ratio is 24, indicating significant disparities.
• Childhood Diseases: Diarrhea and Acute Respiratory Infections (ARI) are more prevalent in poorer children, but the biggest disparities are in treatment. The richest quintile is 2.4 times more likely to treat childhood diarrhea and 4.2 times more likely to treat ARI in health facilities.

Child Health and Nutrition

• Stunting: Moderate and severe stunting is most prevalent in the poorest quintile (39.2%) and least in the richest (8.1%), with a poor-rich ratio of 4.8.
• Underweight: Moderate underweight prevalence is 7.8 times higher in the poorest quintile than in the richest. Severe underweight prevalence is 10.2 times higher in the poorest.
• Gender Disparities: Girls in the poorest quintile are more likely to be severely underweight than boys, while the opposite is true in the richest quintile. Male infants in the poorest quintile are more than twice as likely to die than those in the richest.

Reaching the Poor with Health Services

• The paper suggests that health services and interventions must be targeted at the poorest to effectively address health inequalities.
• Successful interventions that have reached poor communities are highlighted as a basis for future policy development.

Conclusion

The document underscores the critical need to address health, nutrition, and population inequalities in Morocco by focusing on the poorest segments of the population. It argues that targeted interventions, based on wealth quintile data, can lead to more equitable outcomes and contribute to the achievement of the MDGs. The findings emphasize that while progress has been made in some areas, significant disparities remain, particularly in maternal and child health services, and that these must be addressed through improved access and equity in service delivery.

Key Figures and Ratios

• Antenatal Care (ANC): Rich-poor ratio of 9.3 for trained medical personnel and 11.8 for doctors.
• Skilled Delivery Care: Rich-poor ratio of 15.3.
• Moderate Stunting: Poor-rich ratio of 4.8.
• Moderate Underweight: Poor-rich ratio of 7.8.
• Severe Underweight: Poor-rich ratio of 10.2.
• Immunization Coverage: Rich-poor ratio of 24.
• Infant Mortality Rate (IMR): Poor-rich ratio of 2.3.
• Under-5 Mortality Rate (U5MR): Poor-rich ratio of 2.8.

Keywords

Inequality, Morocco, Nutrition, Population, Reproductive Health

Authors

Nandini Oomman, Elizabeth Lule, Deborah Vazirani, and Ritu Chhabra

Disclaimer

The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors and should not be attributed to the World Bank or its affiliated organizations.