Quantifying Wealth-Related Inequalities in Maternal and Child Health: A National Analysis of Madagascar (2015–2022) Using DHS Data

Abstract Background:Socioeconomic inequality remains a central barrier to achieving universal health coverage (UHC) in low-income countries. Methods:Using nationally representative Demographic and Health Survey data (2015–16 and 2021–22), this study quantified wealth-related disparities across 25 maternal and child health indicators in Madagascar. The wealth gap (Q5–Q1) was calculated for each indicator, and 95% confidence intervals were estimated via bootstrap resampling. The pooled dataset included approximately 9,200 women aged 15–49 and 5,000 children under five, weighted for national representativeness. Findings:Across all indicators, the mean wealth gap was 4.2 percentage points (95% CI 3.5–4.9). The widest inequalities were observed in skilled birth attendance (10 pp gap; 95% CI 8–12) and antenatal care by a doctor (8 pp; 95% CI 6–10). Preventive child health indicators displayed moderate but significant gaps (2–6 pp), while curative indicators demonstrated near parity between wealth groups.