HEALTH SYSTEM MORTALITY DETERMINANTS

Wednesday, 9th of November 2011

‘Improving access to water and sanitation and reducing corruption within the health sector should become priorities.’

HEALTH SYSTEM MORTALITY DETERMINANTS

Health system determinants of infant, child and maternal mortality: A cross-sectional study of UN member countries

Katherine A Muldoon, Lindsay P Galway, Maya Nakajima, Steve Kanters, Robert S Hogg, Eran Bendavid and Edward J Mills

Abstract below; full text is at _{http://www.globalizationandhealth.com/content/pdf/1744-8603-7-42.pdf}

Globalization and Health 2011, 7:42 doi:10.1186/1744-8603-7-42

Published: 24 October 2011

Abstract (provisional)

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.

_‘The MDA for lymphatic filariasis in Haiti began in 2000, with the treatment of 105,750 persons at a cost per person of U.S. $2.23. The decrease in cost per person treated is the result of cumulative implementation experience and economies of scale.’