Impact of multisectoral health determinants on child mortality 1980–2010: An analysis by country baseline mortality

Abstract

IntroductionSome health determinants require relatively stronger health system capacity and socioeconomic development than others to impact child mortality. Few quantitative analyses have analyzed how the impact of health determinants varies by mortality level.Methods149 low- and middle-income countries were stratified into high, moderate, low, and very low baseline levels of child mortality in 1990. Data for 52 health determinants were collected for these countries for 1980–2010. To quantify how changes in health determinants were associated with mortality decline, univariable and multivariable regression models were constructed. An advanced statistical technique that is new for child mortality analyses—MM-estimation with first differences and country clustering—controlled for outliers, fixed effects, and variation across decades.FindingsSome health determinants (immunizations, education) were consistently associated with child mortality reduction across all mortality levels. Others (staff availability, skilled birth attendance, fertility, water and sanitation) were associated with child mortality reduction mainly in low or very low mortality settings. The findings indicate that the impact of some health determinants on child mortality was only apparent with stronger health systems, public infrastructure and levels of socioeconomic development, whereas the impact of other determinants was apparent at all stages of development. Multisectoral progress was essential to mortality reduction at all baseline mortality levels.ConclusionPolicy-makers can use such analyses to direct investments in health and non-health sectors and to set five-year child mortality targets appropriate for their baseline mortality levels and local context.

Strong community-based health systems and national governance predict improvement in coverage of oral rehydration solution (ORS): a multilevel longitudinal model

“…That study sought to explain why some countries have reduced maternal and under-five mortality more quickly than comparable ones. The quantitative part of the Success factors study analyzed over 250 different health determinants and found that multi-sectoral improvements in over a dozen policy areas -including immunizations, water and sanitation, and women' s education -contributed additively and synergistically to under-five mortality reduction [26][27][28].…”

“…To identify the independent variables, we constructed a data set of potential predictors from the following sources: (1) predictors identified in prior studies of ORS coverage; (2) variables that were significantly associated with under-5 mortality reduction in the Success Factors study [26][27][28]; and (3) variables reflecting the timing of national child health policies. Using these criteria, we tested 34 indicators as independent variables; all downloaded from the USAID Idea database [32] (Table 1).…”

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“…In vast literature, the water, sanitation, and health nexus has been documented (Montgomery and Elimelech 2007). A study by Cohen et al, (2017) for 194 developing countries from the group of low-and middle-income countries expressed that improved water and sanitation facilities result in decreasing child mortality ratio. Moreover, the studies on the region of South Asia and Sub-Sahara Africa also elucidate the similar association between child health and improved water and sanitation facility.…”

Estimating the Impact of Donor Programs on Child Mortality in Low- and Middle-income Countries: A Synthetic Control Analysis of Child Health Programs Funded by the United States Agency for International Development

“…The Success Factors Study for Women's and Children's Health examined over 250 indicators for data availability and potential to associate with declines in child mortality. [27,28] It divided these many variables into 11 different policy areas (Table 1). It found that these policy areas contributed additively to child mortality reduction, and that approximately half of the gains in child mortality came from improvements in coverage in the health sector (e.g.…”