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Decomposing Kenyan socio-economic inequalities in skilled birth attendance and measles immunization

Carine Van Malderen1*, Irene Ogali2, Anne Khasakhala3, Stephen N Muchiri4, Corey Sparks5, Herman Van Oyen6 and Niko Speybroeck1

Author Affiliations

1 Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium

2 Veterinary Research Centre, Kenya Agricultural Research Institute, Kikuyu, Kenya

3 Population Studies Research Institute (PSRI), University of Nairobi, Nairobi, Kenya

4 Futures Group, Nairobi, Kenya

5 Department of Demography, University of Texas, San Antonio, USA

6 Unit of Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium

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International Journal for Equity in Health 2013, 12:3  doi:10.1186/1475-9276-12-3

Published: 7 January 2013



Skilled birth attendance (SBA) and measles immunization reflect two aspects of a health system. In Kenya, their national coverage gaps are substantial but could be largely improved if the total population had the same coverage as the wealthiest quintile. A decomposition analysis allows identifying the factors that influence these wealth-related inequalities in order to develop appropriate policy responses. The main objective of the study was to decompose wealth-related inequalities in SBA and measles immunization into their contributing factors.


Data from the Kenyan Demographic and Health Survey 2008/09 were used. The study investigated the effects of socio-economic determinants on [1] coverage and [2] wealth-related inequalities of SBA utilization and measles immunization. Techniques used were multivariate logistic regression and decomposition of the concentration index (C).


SBA utilization and measles immunization coverage differed according to household wealth, parent’s education, skilled antenatal care visits, birth order and father’s occupation. SBA utilization further differed across provinces and ethnic groups. The overall C for SBA was 0.14 and was mostly explained by wealth (40%), parent’s education (28%), antenatal care (9%), and province (6%). The overall C for measles immunization was 0.08 and was mostly explained by wealth (60%), birth order (33%), and parent’s education (28%). Rural residence (−19%) reduced this inequality.


Both health care indicators require a broad strengthening of health systems with a special focus on disadvantaged sub-groups.

Kenya; Skilled birth attendance; Measles immunization; Socio-economic inequalities; Concentration index; Decomposition