1. The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh
- Author
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Tanvir M. Huda, Tazeen Tahsina, Shams El Arifeen, and Michael J. Dibley
- Subjects
Male ,inequality ,neonatal mortality ,Social Determinants of Health ,universal health coverage ,under-five mortality ,0302 clinical medicine ,Social determinants of health ,infant mortality ,health inequality ,inter-sectoral action ,Bangladesh ,Risk Factors ,Universal Health Insurance ,intersectoral action ,Infant Mortality ,Medicine ,030212 general & internal medicine ,Geography, Medical ,Socioeconomics ,education.field_of_study ,Health Policy ,lcsh:Public aspects of medicine ,Multilevel model ,Health equity ,Child, Preschool ,Child Mortality ,Multilevel Analysis ,Female ,0305 other medical science ,Adult ,Population ,Mothers ,Population health ,03 medical and health sciences ,Humans ,education ,Public Health ,Global Health ,Health Systems ,Community Health ,Population Health ,Socioeconomic status ,Demography ,030505 public health ,business.industry ,Monitoring Health Determinants with an Equity Focus ,Public Health, Environmental and Occupational Health ,Infant, Newborn ,Infant ,lcsh:RA1-1270 ,Health Status Disparities ,Infant mortality ,Child mortality ,inequity ,Socioeconomic Factors ,business - Abstract
Introduction: Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly.Objectives: This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother’s level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions).Design: We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality.Results: The study found that the mother’s age, the education of both parents, the mother’s autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh.Conclusion: The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.Keywords: social determinants of health; inequality; inequity; universal health coverage; neonatal mortality; infant mortality; under-five mortality; health inequality; intersectoral action; Bangladesh(Published: 12 February 2016)Citation: Glob Health Action 2016, 9: 29741 - http://dx.doi.org/10.3402/gha.v9.29741Special issue: This paper is part of the Special Issue: Monitoring health determinants with an equity focus. More papers from this issue can be found at www.globalhealthaction.net
- Published
- 2016