Problems in accessing health care and child survival in 49 low- and middle-income countries

BACKGROUND: Access to health care remains suboptimal in many LMICs and continues to hinder children's survival. We aimed to systematically assess the association between problems accessing health care (PAHC) and U5M at the global-, regional-, and country level. METHODS: Data came from the latest Demographic and Health Surveys of 49 LMICs (2013-2021). Child mortality data were available on 721,658 live births born to mothers aged 15-49 years within the five years preceding the survey. Three domains of PAHC were defined for women who identified the following reasons as PAHC for themselves when they are sick: “money needed for treatment” (economic), “distance to health facility” (physical), “getting permission” or “not wanting to go alone” (socio-cultural). Multivariable logistic regression models were used to estimate the association between PAHC (any and by each type) and U5M. RESULTS: In our pooled sample, 4.7% of children died before age of five and 58.4% of mothers reported experiencing PAHC (ranging from 43.2% in Europe & Central Asia to 71.0% in Latin America & Caribbean). Economic PAHC was the most prevalent (42.7%), followed by physical (36.9%) and socio-cultural (35.2%). After adjusting for a comprehensive set of covariates, children of mothers with any PAHC had higher odds of U5M (OR: 1.05, 95% CI: 1.01, 1.08), and this association was especially significant in Sub-Saharan Africa. Of the different domains of PAHC, socio-cultural PAHC was found to have the strongest association with U5M. CONCLUSIONS: Our findings suggest the need to improve access to health care in LMICs by expanding health care coverage, building health facilities, and focusing more on context-specific socio-cultural barriers to encompass marginalised populations. KEY MESSAGES: • More than half of mothers in low-and middle-income countries had problems accessing health care, and it was associated with increased risk of under-five mortality in children. • To improve child survival in low-and middle-income countries, economic, physical, and socio-cultural barriers to health care should be improved.