{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:08:16Z","timestamp":1789668496023,"version":"4.0.1"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u201349) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009&lt;\u20090.001), 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\u2019 educational level (11.62%), region (6.84%), antenatal care follow-up (4.49), and mode of delivery (3.37%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u2019s access to newborn health services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358220","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:36:26Z","timestamp":1789666586000},"page":"e0358220","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Wealth-related inequality in effective coverage of postnatal newborn care in Tanzania; A decomposition analysis of the Tanzania Demographic and Health Survey, 2022"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0960-3759","authenticated-orcid":true,"given":"Amanuel Yosef","family":"Gebrekidan","sequence":"first","affiliation":[{"name":"Wolaita Sodo University","place":["Wolaita Sodo, Ethiopia"],"department":["School of Public Health, College of Health Sciences and Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yordanos Sisay","family":"Asgedom","sequence":"additional","affiliation":[{"name":"Wolaita Sodo University","place":["Wolaita Sodo, Ethiopia"],"department":["School of Public Health, College of Health Sciences and Medicine"]},{"name":"Edith Cowan University","place":["Perth, Western Australia, Australia"],"department":["School of Nursing and Midwifery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9340-0091","authenticated-orcid":true,"given":"Mesfin","family":"Abebe","sequence":"additional","affiliation":[{"name":"Dilla University","place":["Dilla, Ethiopia"],"department":["Department of Midwifery, College of Health Sciences and Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsion Mulat","family":"Tebeje","sequence":"additional","affiliation":[{"name":"Dilla University","place":["Dilla, Ethiopia"],"department":["School of Public Health, College of Health Sciences and Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kassahun Animut","family":"Metkie","sequence":"additional","affiliation":[{"name":"Dilla University","place":["Dilla, Ethiopia"],"department":["Department of Statistics, College of Natural and Computational Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simegn Molla","family":"Degisew","sequence":"additional","affiliation":[{"name":"Wolaita Sodo University","place":["Wolaita Sodo, Ethiopia"],"department":["School of Public Health, College of Health Sciences and Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1303-6761","authenticated-orcid":true,"given":"Kirubel Eshetu","family":"Haile","sequence":"additional","affiliation":[{"name":"Wolaita Sodo University","place":["Wolaita Sodo, Ethiopia"],"department":["School of Nursing, College of Health Sciences and Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3939-0135","authenticated-orcid":true,"given":"Seblewongel Gebretsadik","family":"Sertsewold","sequence":"additional","affiliation":[{"name":"Debrebirhan University","place":["Debrebirhan, Ethiopia"],"department":["School of Public Health, Asrat Woldeyes Health Science Campus"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gizachew Ambaw","family":"Kassie","sequence":"additional","affiliation":[{"name":"Wolaita Sodo University","place":["Wolaita Sodo, Ethiopia"],"department":["School of Public Health, College of Health Sciences and Medicine"]},{"name":"University of Southern Queensland","place":["Toowoomba, Queensland, Australia"],"department":["School of Business, Law, Humanities and Pathways (BLHP)"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"pone.0358220.ref001","author":"United Nations","year":"2024"},{"issue":"6","key":"pone.0358220.ref002","article-title":"National, regional, and global levels and trends in neonatal mortality between 1990 and 2017, with scenario-based projections to 2030: a systematic analysis","volume":"7","author":"UN Inter-agency Group for Child Mortality Estimation","year":"2019","journal-title":"Lancet Glob Health"},{"key":"pone.0358220.ref003","doi-asserted-by":"crossref","DOI":"10.1038\/jp.2016.183","article-title":"State of newborn health in India","volume":"36","author":"MJ Sankar","year":"2016","journal-title":"J Perinatol"},{"key":"pone.0358220.ref004","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12942-015-0012-x","article-title":"The geography of maternal and newborn health: the state of the art","volume":"14","author":"S Ebener","year":"2015","journal-title":"Int J Health Geogr"},{"key":"pone.0358220.ref005","author":"World Health Organization","year":"2024"},{"key":"pone.0358220.ref006","volume-title":"Stillbirth, and causes of death estimates","author":"UN Inter-agency Group for Child Mortality Estimation","year":"2024"},{"key":"pone.0358220.ref007","volume-title":"UNICEF data: monitoring the situation of children and women","author":"UNICEF","year":"2023"},{"key":"pone.0358220.ref008","volume-title":"UNICEF data: monitoring the situation of children and women","author":"UNICEF","year":"2016"},{"key":"pone.0358220.ref009","volume-title":"Postnatal Care for Mothers and Newborns Highlights from the World Health Organization 2013 Guidelines","author":"World Health Organization","year":"2015"},{"key":"pone.0358220.ref010","volume-title":"WHO recommendations on maternal and newborn care for a positive postnatal experience","author":"World Health organization","year":"2022"},{"key":"pone.0358220.ref011","volume-title":"Health Sector Strategic Plan July 2021\u2014June 2026","author":"United Republic of Tanzania MoHCDGEaC","year":"2021"},{"key":"pone.0358220.ref012","author":"World Health Organization"},{"issue":"1","key":"pone.0358220.ref013","doi-asserted-by":"crossref","first-page":"2067398","DOI":"10.1080\/16549716.2022.2067398","article-title":"Essential newborn care practices for healthy newborns at a district hospital in Pemba, Tanzania: a cross-sectional observational study utilizing video recordings","volume":"15","author":"CN Stensgaard","year":"2022","journal-title":"Glob Health Action"},{"issue":"1","key":"pone.0358220.ref014","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/s12939-021-01452-z","article-title":"Equity in newborn care, evidence from national surveys in low- and middle-income countries","volume":"20","author":"K Peven","year":"2021","journal-title":"Int J Equity Health"},{"issue":"10","key":"pone.0358220.ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0293520","article-title":"Effective coverage of newborn postnatal care in Ethiopia: measuring inequality and spatial distribution of quality-adjusted coverage","volume":"18","author":"AF Gebremedhin","year":"2023","journal-title":"PLoS One"},{"key":"pone.0358220.ref016","doi-asserted-by":"crossref","first-page":"1384729","DOI":"10.3389\/fpubh.2024.1384729","article-title":"Measuring socioeconomic inequalities in postnatal health checks for newborns in Ethiopia: a decomposition analysis","volume":"12","author":"A Hagos","year":"2024","journal-title":"Front Public Health"},{"issue":"9","key":"pone.0358220.ref017","article-title":"Effective coverage: a metric for monitoring Universal Health Coverage","volume":"11","author":"M Ng","year":"2014","journal-title":"PLoS Med"},{"key":"pone.0358220.ref018","volume-title":"The 2022 Population and Housing Census: Administrative Units Population Distribution Report","author":"The United Republic of Tanzania (URT) MoFaP, Tanzania National Bureau of Statistics, President\u2019s Office - Finance and Planning, Office of the Chief Government Statistician, Zanzibar","year":"2022"},{"key":"pone.0358220.ref019","volume-title":"Tanzania Demographic and Health Survey and Malaria Indicator Survey 2022 Final Report","author":"Ministry of Health (MoH) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), ICF a","year":"2022"},{"key":"pone.0358220.ref020","first-page":"292","volume-title":"Guide to DHS statistics, vol. 645","author":"TN Croft","year":"2018"},{"issue":"12","key":"pone.0358220.ref021","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"12","author":"E von Elm","year":"2014","journal-title":"Int J Surg"},{"issue":"1","key":"pone.0358220.ref022","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12884-019-2184-z","article-title":"Quality of intrapartum and newborn care in Tigray, Northern Ethiopia","volume":"19","author":"G Fisseha","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"issue":"2","key":"pone.0358220.ref023","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0298459","article-title":"Assessing postnatal care for newborns in Sub-Saharan Africa: a multinational analysis","volume":"19","author":"HB Eshetu","year":"2024","journal-title":"PLoS One"},{"issue":"2","key":"pone.0358220.ref024","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0282012","article-title":"Spatial distribution and determinants of newborn care within 2 days of postpartum period among women with at least one antenatal care visit in Ethiopia: mixed effect multilevel analysis","volume":"18","author":"MH Asratie","year":"2023","journal-title":"PLoS One"},{"key":"pone.0358220.ref025","doi-asserted-by":"crossref","first-page":"1052016","DOI":"10.3389\/fpubh.2023.1052016","article-title":"A multilevel analysis of factors associated with vitamin A supplementation among children aged 6-35 months in Ethiopia","volume":"11","author":"T Amare","year":"2023","journal-title":"Front Public Health"},{"issue":"5","key":"pone.0358220.ref026","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0000517","article-title":"Multilevel analysis of continuation of maternal healthcare services utilization and its associated factors in Ethiopia: a cross-sectional study","volume":"2","author":"EE Chaka","year":"2022","journal-title":"PLOS Glob Public Health"},{"issue":"2","key":"pone.0358220.ref027","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/j.jhealeco.2008.02.003","article-title":"Correcting the concentration index","volume":"28","author":"G Erreygers","year":"2009","journal-title":"J Health Econ"},{"key":"pone.0358220.ref028","volume-title":"Analyzing health equity using household survey data: a guide to techniques and their implementation","author":"A Wagstaff","year":"2007"},{"issue":"4","key":"pone.0358220.ref029","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1002\/hec.953","article-title":"The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality","volume":"14","author":"A Wagstaff","year":"2005","journal-title":"Health Econ"},{"issue":"1","key":"pone.0358220.ref030","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/S0304-4076(96)01807-6","article-title":"Socioeconomic inequalities in health: measurement, computation, and statistical inference","volume":"77","author":"N Kakwani","year":"1997","journal-title":"J Econom"},{"issue":"1","key":"pone.0358220.ref031","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S0304-4076(02)00161-6","article-title":"On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam","volume":"112","author":"A Wagstaff","year":"2003","journal-title":"J Econom"},{"issue":"5","key":"pone.0358220.ref032","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1093\/heapol\/czaa192","article-title":"Poor coverage and quality for poor women: inequalities in quality antenatal care in nine East African countries","volume":"36","author":"FT Bobo","year":"2021","journal-title":"Health Policy Plan"},{"issue":"1","key":"pone.0358220.ref033","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1186\/s12939-017-0602-2","article-title":"Inequities in utilization of reproductive and maternal health services in Ethiopia","volume":"16","author":"FT Bobo","year":"2017","journal-title":"Int J Equity Health"},{"key":"pone.0358220.ref034","doi-asserted-by":"crossref","first-page":"595","DOI":"10.2147\/CEOR.S269955","article-title":"Inequities in the uptake of reproductive and maternal health services in the biggest regional state of Ethiopia: too far from \u201cLeaving no one behind\u201d","volume":"12","author":"DW Daka","year":"2020","journal-title":"Clinicoecon Outcomes Res"},{"issue":"11","key":"pone.0358220.ref035","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(18)30389-9","article-title":"Equity in antenatal care quality: an analysis of 91 national household surveys","volume":"6","author":"C Arsenault","year":"2018","journal-title":"Lancet Glob Health"},{"issue":"2","key":"pone.0358220.ref036","doi-asserted-by":"crossref","first-page":"020501","DOI":"10.7189\/jogh.07.020501","article-title":"Gap between contact and content in maternal and newborn care: an analysis of data from 20 countries in sub-Saharan Africa","volume":"7","author":"L Carvajal-Aguirre","year":"2017","journal-title":"J Glob Health"},{"key":"pone.0358220.ref037","doi-asserted-by":"crossref","first-page":"94","DOI":"10.3389\/fpubh.2018.00094","article-title":"Place of delivery associated with postnatal care utilization among childbearing women in Zambia","volume":"6","author":"C Chungu","year":"2018","journal-title":"Front Public Health"},{"key":"pone.0358220.ref038","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1186\/1471-2393-14-114","article-title":"Is antenatal care preparing mothers to care for their newborns? A community-based cross-sectional study among lactating women in Masindi, Uganda","volume":"14","author":"R Mangwi Ayiasi","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"issue":"2","key":"pone.0358220.ref039","doi-asserted-by":"crossref","first-page":"020507","DOI":"10.7189\/jogh.07.020507","article-title":"Postnatal care for newborns in Bangladesh: the importance of health-related factors and location","volume":"7","author":"K Singh","year":"2017","journal-title":"J Glob Health"},{"issue":"1","key":"pone.0358220.ref040","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s41043-017-0107-z","article-title":"Association of antenatal care and place of delivery with newborn care practices: evidence from a cross-sectional survey in rural Uttar Pradesh, India","volume":"36","author":"N Devasenapathy","year":"2017","journal-title":"J Health Popul Nutr"},{"key":"pone.0358220.ref041","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1186\/1471-2458-14-634","article-title":"What interventions are effective on reducing inequalities in maternal and child health in low- and middle-income settings? A systematic review","volume":"14","author":"B Yuan","year":"2014","journal-title":"BMC Public Health"},{"key":"pone.0358220.ref042","doi-asserted-by":"crossref","first-page":"321","DOI":"10.11604\/pamj.2015.21.321.6527","article-title":"Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria","volume":"21","author":"T Dahiru","year":"2015","journal-title":"Pan Afr Med J"},{"issue":"1","key":"pone.0358220.ref043","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1186\/s12913-020-05485-y","article-title":"Factors associated with the perceived barriers of health care access among reproductive-age women in Ethiopia: a secondary data analysis of 2016 Ethiopian demographic and health survey","volume":"20","author":"KS Tamirat","year":"2020","journal-title":"BMC Health Serv Res"},{"issue":"1","key":"pone.0358220.ref044","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/s12884-020-2804-7","article-title":"Essential newborn care utilization and associated factors in Ethiopia: a systematic review and meta-analysis","volume":"20","author":"Y Alamneh","year":"2020","journal-title":"BMC Pregnancy Childbirth"},{"issue":"10","key":"pone.0358220.ref045","doi-asserted-by":"crossref","first-page":"812","DOI":"10.2471\/BLT.06.035659","article-title":"A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context","volume":"85","author":"L Say","year":"2007","journal-title":"Bull World Health Organ"},{"issue":"9","key":"pone.0358220.ref046","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0222582","article-title":"Factors associated with newborn care knowledge and practices in the upper Himalayas","volume":"14","author":"DR Singh","year":"2019","journal-title":"PLoS One"},{"issue":"2","key":"pone.0358220.ref047","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0117996","article-title":"Rural\/urban and socioeconomic differentials in quality of antenatal care in Ghana","volume":"10","author":"PA Afulani","year":"2015","journal-title":"PLoS One"},{"key":"pone.0358220.ref048","author":"N Cowling","year":"2024"},{"issue":"1","key":"pone.0358220.ref049","doi-asserted-by":"crossref","first-page":"2269746","DOI":"10.1080\/27658511.2023.2269746","article-title":"GDP, health expenditure, industrialization, education and environmental sustainability impact on child mortality: evidence from G-7 countries","volume":"9","author":"S Akter","year":"2023","journal-title":"Sustain Environ"},{"issue":"6","key":"pone.0358220.ref050","doi-asserted-by":"crossref","DOI":"10.2105\/AJPH.2019.305001","article-title":"Impact of political economy on population health: a systematic review of reviews","volume":"109","author":"G McCartney","year":"2019","journal-title":"Am J Public Health"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358220","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:36:35Z","timestamp":1789666595000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358220"}},"subtitle":[],"editor":[{"given":"Pritam","family":"Ghosh","sequence":"first","affiliation":[{"name":"Hijli College","place":["INDIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":50,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0358220","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]}}}