Abstract：
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.
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.
摘要：
背景：在低收入和中等收入国家（LMICs），获得医疗保健的机会仍然不理想，并且继续阻碍儿童早期的生存。我们系统地评估了获得医疗保健问题（PAHC）与五岁以下儿童死亡率（U5M）之间的关系。
方法：来自最新的50个低收入国家（2013-2021年）的人口和健康调查的724335个活产的儿童死亡率数据。PAHC的原因分为三个领域：“治疗所需的资金”（经济），\'到医疗机构的距离\'（物理），\'获得许可\'或\'不想一个人走\'（社会文化）。使用多变量逻辑回归来估计PAHC（任何类型和每种类型）与U5M之间的关联。
结果：在我们的合并样本中，每1000名活产中有47.3名儿童在5岁之前死亡，57.1％的人报告经历过PAHC（从欧洲和中亚的45.3％到拉丁美洲和加勒比地区的72.7％）。患有任何PAHC的儿童患U5M的几率更高(OR:1.05,95%CI:1.02,1.09),这种关联在撒哈拉以南非洲尤其显著。在PAHC的不同领域，社会文化PAHC被发现是最重要的。
结论：需要通过扩大医疗保健覆盖面来改善中低收入国家获得医疗保健的机会，建设卫生设施，并更多地关注特定环境的社会文化障碍。
方法：来自最新的50个低收入国家（2013-2021年）的人口和健康调查的724335个活产的儿童死亡率数据。PAHC的原因分为三个领域：“治疗所需的资金”（经济），\'到医疗机构的距离\'（物理），\'获得许可\'或\'不想一个人走\'（社会文化）。使用多变量逻辑回归来估计PAHC（任何类型和每种类型）与U5M之间的关联。
结果：在我们的合并样本中，每1000名活产中有47.3名儿童在5岁之前死亡，57.1％的人报告经历过PAHC（从欧洲和中亚的45.3％到拉丁美洲和加勒比地区的72.7％）。患有任何PAHC的儿童患U5M的几率更高(OR:1.05,95%CI:1.02,1.09),这种关联在撒哈拉以南非洲尤其显著。在PAHC的不同领域，社会文化PAHC被发现是最重要的。
结论：需要通过扩大医疗保健覆盖面来改善中低收入国家获得医疗保健的机会，建设卫生设施，并更多地关注特定环境的社会文化障碍。
