BMC Health Serv Res. 2025 Sep 9;25(1):1193. doi: 10.1186/s12913-025-13393-2.
ABSTRACT
BACKGROUND: Maternal healthcare (MHC) in Cameroon reflects the persistent challenges in Sub-Saharan Africa, where high maternal mortality continues despite improved service utilization, stressing inequitable effective coverage (EC). This study applied EC cascade analysis-including service contact, continuity, and input-adjusted coverage-to quantify geographic and socioeconomic disparities, informing equity-focused strategies to dismantle structural barriers in the MHC continuum.
METHODS: We combined population and health facility data (2018 Cameroon Demographic and Health Survey and 2015 Emergency Obstetric and Neonatal Care Assessment) to estimate the input-adjusted coverage of antenatal care (ANC) and intra-and postpartum care (IPC). Inequalities were assessed using absolute and relative measures.
RESULTS: The MHC cascade showed significant falls in input-adjusted coverage. For ANC, 86.3% service contact eroded to 25.3% continuity and 14.4% input-adjusted coverage. For IPC, the service continuum dropped from 51.4 to 31.4% input-adjusted coverage, revealing steeper losses compared to ANC (20.0% vs. 10.9%). When accounting for service readiness, relative inequalities intensified (e.g., the wealth-based RII for ANC increased by 122%), while absolute gaps narrowed (SII declined by 25%), indicating a greater loss of coverage among socioeconomically privileged groups (IPC input-adjusted coverage dropped by 20.9% for the highest quintile vs. 11.1% for the lowest quintile). At the same time, marginalized populations experienced compounded exclusion-facing severely limited access to care and substandard service quality at available facilities-highlighting the critical need to improve both access and quality.
CONCLUSION: Cameroon’s MHC disparities stem from systemic resource and quality gaps. Integrating absolute and relative inequality metrics into policy frameworks can dismantle structural biases, aligning interventions with continuum-of-care strategies to prevent avoidable mortality.
PMID:40926204 | DOI:10.1186/s12913-025-13393-2
