Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countries
Open Access
- 24 October 2011
- journal article
- Published by Springer Science and Business Media LLC in Globalization and Health
- Vol. 7 (1), 42
- https://doi.org/10.1186/1744-8603-7-42
Abstract
Objective Few studies have examined the link between health system strength and important public health outcomes across nations. We examined the association between health system indicators and mortality rates. Methods We used mixed effects linear regression models to investigate the strength of association between outcome and explanatory variables, while accounting for geographic clustering of countries. We modelled infant mortality rate (IMR), child mortality rate (CMR), and maternal mortality rate (MMR) using 13 explanatory variables as outlined by the World Health Organization. Results Significant protective health system determinants related to IMR included higher physician density (adjusted rate ratio [aRR] 0.81; 95% Confidence Interval [CI] 0.71-0.91), higher sustainable access to water and sanitation (aRR 0.85; 95% CI 0.78-0.93), and having a less corrupt government (aRR 0.57; 95% CI 0.40-0.80). Out-of-pocket expenditures on health (aRR 1.29; 95% CI 1.03-1.62) were a risk factor. The same four variables were significantly related to CMR after controlling for other variables. Protective determinants of MMR included access to water and sanitation (aRR 0.88; 95% CI 0.82-0.94), having a less corrupt government (aRR 0.49; 95%; CI 0.36-0.66), and higher total expenditures on health per capita (aRR 0.84; 95% CI 0.77-0.92). Higher fertility rates (aRR 2.85; 95% CI: 2.02-4.00) were found to be a significant risk factor for MMR. Conclusion Several key measures of a health system predict mortality in infants, children, and maternal mortality rates at the national level. Improving access to water and sanitation and reducing corruption within the health sector should become priorities.This publication has 24 references indexed in Scilit:
- Water and sanitation infrastructure for health: The impact of foreign aidGlobalization and Health, 2010
- Factors associated with maternal mortality in Sub-Saharan Africa: an ecological studyBMC Public Health, 2009
- Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership?Human Resources for Health, 2009
- The 'diagonal' approach to Global Fund financing: a cure for the broader malaise of health systems?Globalization and Health, 2008
- Can a bank crisis break your heart?Globalization and Health, 2008
- Achieving health equity: from root causes to fair outcomesThe Lancet, 2007
- Human resources for health planning and management in the Eastern Mediterranean region: facts, gaps and forward thinking for research and policyHuman Resources for Health, 2007
- Factors affecting infant mortality rates: evidence from cross–sectional dataApplied Economics Letters, 1999
- Social and environmental factors and life expectancy, infant mortality, and maternal mortality rates: Results of a cross-national comparisonSocial Science & Medicine (1982), 1994
- Vertical vs horizontal health programmes in Africa: Idealism, pragmatism, resources and efficiencySocial Science & Medicine (1982), 1983