{Reference Type}: Journal Article
{Title}: Problems accessing health care and under-5 mortality: a pooled analysis of 50 low- and middle-income countries.
{Author}: Kim J;Eom YJ;Ko S;Subramanian SV;Kim R;
{Journal}: J Public Health (Oxf)
{Volume}: 46
{Issue}: 3
{Year}: 2024 Aug 25
{Factor}: 5.058
{DOI}: 10.1093/pubmed/fdae053
{Abstract}: <B>BACKGROUND: </B>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).<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.