Problems accessing health care and under-5 mortality: a pooled analysis of 50 low- and middle-income countries
Jinseo Kim1, Yun-Jung Eom1, Soohyeon Ko1
1Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea.
Insights
Problems accessing health care (PAHC) are linked to higher under-five mortality (U5M) in low- and middle-income countries. Socio-cultural barriers are the most significant factor contributing to child mortality.
Area of Science:
- Global Health
- Pediatric Mortality
- Health Services Research
Background:
- Suboptimal healthcare access in low- and middle-income countries (LMICs) significantly impacts early childhood survival.
- Problems accessing health care (PAHC) are a critical barrier to child survival in LMICs.
Purpose of the Study:
- To systematically assess the association between problems accessing health care (PAHC) and under-five mortality (U5M).
- To identify specific domains of PAHC that contribute most significantly to U5M.
Main Methods:
- Utilized data from Demographic and Health Surveys in 50 LMICs (2013-2021) covering 724,335 livebirths.
- Classified PAHC into economic, physical, and socio-cultural domains.
- Employed multivariable logistic regression to analyze the relationship between PAHC and U5M.
Main Results:
- The pooled under-five mortality rate was 47.3 per 1000 livebirths.
- Over half (57.1%) of participants reported PAHC, with significant regional variation.
- Any PAHC was associated with increased odds of U5M (OR: 1.05, 95% CI: 1.02, 1.09), particularly in sub-Saharan Africa.
- Socio-cultural barriers to accessing care demonstrated the most significant association with U5M.
Conclusions:
- Improving healthcare access in LMICs is crucial for reducing under-five mortality.
- Strategies should focus on expanding healthcare coverage, enhancing physical infrastructure, and addressing context-specific socio-cultural barriers to care access.
Background:
Access to health care remains suboptimal in low- and middle-income countries (LMICs) and continues to hinder survival in early childhood. We systematically assessed the association between problems accessing health care (PAHC) and under-five mortality (U5M).
Methods:
Child mortality data on 724 335 livebirths came from the latest Demographic and Health Surveys of 50 LMICs (2013-2021). Reasons for PAHC were classified into three domains: 'money needed for treatment' (economic), 'distance to health facility' (physical), 'getting permission' or 'not wanting to go alone' (socio-cultural). Multivariable logistic regression was used to estimate the association between PAHC (any and by each type) and U5M.
Results:
In our pooled sample, 47.3 children per 1000 livebirths died before age of 5, and 57.1% reported having experienced PAHC (ranging from 45.3% in Europe & Central Asia to 72.7% in Latin America & Caribbean). Children with any PAHC had higher odds of U5M (OR: 1.05, 95% CI: 1.02, 1.09), and this association was especially significant in sub-Saharan Africa. Of different domains of PAHC, socio-cultural PAHC was found to be most significant.
Conclusions:
Access to health care in LMICs needs to be improved by expanding health care coverage, building health facilities, and focusing more on context-specific socio-cultural barriers.
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