Wealth-related inequality in effective coverage of postnatal newborn care in Tanzania; A decomposition analysis of the Tanzania Demographic and Health Survey, 2022

BACKGROUND: Effective postnatal newborn care provision is proven to be one effective strategy to reduce neonatal and under-five mortality. Despite the presence of small-scale studies that reported crude coverage of postnatal newborn care, nationwide evidence about effective postnatal newborn care coverage and evidence regarding the status of wealth-related inequality are limited in Tanzania. Therefore, this study aimed to assess the status of wealth-related inequality and determinants in effective coverage of postnatal newborn care in Tanzania. METHODS: A secondary data analysis was conducted based on cross-sectional data from the 2022 Tanzania Demographic and Health Survey. 4335 weighted samples of reproductive age-women (15-49) who had given birth in the two years preceding the survey were included. The Erreygers normalized concentration index and graph approach were employed to evaluate wealth-related inequality in effective coverage of postnatal newborn care. Additionally, a decomposition analysis was used to decompose the overall wealth-related inequality by determinant factors. RESULTS: The proportion of newborns who received effective postnatal newborn care interventions in Tanzania was 22.70% [95% CI: 21.48, 23.97]. A significant pro-rich wealth-related inequality in effective coverage of postnatal newborn care, with an Erreygers concentration index value of 0.26 (95% CI: 0.24, 0.29) (P < 0.001), was found. The decomposition result showed the most significant factors leading to the overall inequality were place of delivery (68.43%), residence (22.72%), mothers' educational level (11.62%), region (6.84%), antenatal care follow-up (4.49), and mode of delivery (3.37%). CONCLUSION: The study found a low level of effective postnatal newborn care coverage, with a pro-rich distribution. Focus should be given on increasing institutional deliveries, expanding education, promoting ANC follow-up, improving wealth status, and newborns from vaginal deliveries. Furthermore, authorities and stakeholders should work on expanding health services in rural and affected regions to increase the population's access to newborn health services.