Progress towards universal health coverage and inequalities in infant mortality

Bibliographic Details
Main Author: Hone, Thomas
Publication Date: 2024
Other Authors: Gonçalves, Judite, Seferidi, Paraskevi, Moreno-Serra, Rodrigo, Rocha, Rudi, Gupta, Indrani, Bhardwaj, Vinayak, Hidayat, Taufik, Cai, Chang, Suhrcke, Marc, Millett, Christopher
Format: Article
Language: eng
Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
Download full: http://hdl.handle.net/10362/168505
Summary: Funding Information: This research was funded by the UK National Institute for Health and Care Research (grant numbers NIHR133252 and NIHR150067) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the UK Department of Health and Social Care. Publisher Copyright: © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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spelling Progress towards universal health coverage and inequalities in infant mortalityan analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019Medicine(all)SDG 3 - Good Health and Well-beingFunding Information: This research was funded by the UK National Institute for Health and Care Research (grant numbers NIHR133252 and NIHR150067) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the UK Department of Health and Social Care. Publisher Copyright: © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Expanding universal health coverage (UHC) might not be inherently beneficial to poorer populations without the explicit targeting and prioritising of low-income populations. This study examines whether the expansion of UHC between 2000 and 2019 is associated with reduced socioeconomic inequalities in infant mortality in low-income and middle-income countries (LMICs). Methods: We did a retrospective analysis of birth data compiled from Demographic and Health Surveys (DHSs). We analysed all births between 2000 and 2019 from all DHSs available for this period. The primary outcome was infant mortality, defined as death within 1 year of birth. Logistic regression models with country and year fixed effects assessed associations between country-level progress to UHC (using WHO's UHC service coverage index) and infant mortality (overall and by wealth quintile), adjusting for infant-level, mother-level, and country-level variables. Findings: A total of 4 065 868 births to 1 833 011 mothers were analysed from 177 DHSs covering 60 LMICs between 2000 and 2019. A one unit increase in the UHC index was associated with a 1·2% reduction in the risk of infant death (AOR 0·988, 95% CI 0·981–0·995; absolute measure of association, 0·57 deaths per 1000 livebirths). An estimated 15·5 million infant deaths were averted between 2000 and 2019 because of increases in UHC. However, richer wealth quintiles had larger associated reductions in infant mortality from UHC (quintile 5 AOR 0·983, 95% CI 0·973–0·993) than poorer quintiles (quintile 1 0·991, 0·985–0·998). In the early stages of UHC, UHC expansion was generally beneficial to poorer populations (ie, larger reductions in infant mortality for poorer households [infant deaths per 1000 per one unit increase in UHC coverage: quintile 1 0·84 vs quintile 5 0·59]), but became less so as overall coverage increased (quintile 1 0·64 vs quintile 5 0·57). Interpretation: Since UHC expansion in LMICs appears to become less beneficial to poorer populations as coverage increases, UHC policies should be explicitly designed to ensure lower income groups continue to benefit as coverage expands. Funding: UK National Institute for Health and Care Research.Escola Nacional de Saúde Pública (ENSP)Centro de Investigação em Saúde Pública (CISP/PHRC)Comprehensive Health Research Centre (CHRC) - Pólo ENSPRUNHone, ThomasGonçalves, JuditeSeferidi, ParaskeviMoreno-Serra, RodrigoRocha, RudiGupta, IndraniBhardwaj, VinayakHidayat, TaufikCai, ChangSuhrcke, MarcMillett, Christopher2024-06-13T00:33:24Z2024-052024-05-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10362/168505eng2214-109XPURE: 93225038https://doi.org/10.1016/S2214-109X(24)00040-8info:eu-repo/semantics/openAccessreponame:Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)instname:FCCN, serviços digitais da FCT – Fundação para a Ciência e a Tecnologiainstacron:RCAAP2024-06-24T01:35:29Zoai:run.unl.pt:10362/168505Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireinfo@rcaap.ptopendoar:https://opendoar.ac.uk/repository/71602025-05-28T17:55:46.945801Repositórios Científicos de Acesso Aberto de Portugal (RCAAP) - FCCN, serviços digitais da FCT – Fundação para a Ciência e a Tecnologiafalse
dc.title.none.fl_str_mv Progress towards universal health coverage and inequalities in infant mortality
an analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019
title Progress towards universal health coverage and inequalities in infant mortality
spellingShingle Progress towards universal health coverage and inequalities in infant mortality
Hone, Thomas
Medicine(all)
SDG 3 - Good Health and Well-being
title_short Progress towards universal health coverage and inequalities in infant mortality
title_full Progress towards universal health coverage and inequalities in infant mortality
title_fullStr Progress towards universal health coverage and inequalities in infant mortality
title_full_unstemmed Progress towards universal health coverage and inequalities in infant mortality
title_sort Progress towards universal health coverage and inequalities in infant mortality
author Hone, Thomas
author_facet Hone, Thomas
Gonçalves, Judite
Seferidi, Paraskevi
Moreno-Serra, Rodrigo
Rocha, Rudi
Gupta, Indrani
Bhardwaj, Vinayak
Hidayat, Taufik
Cai, Chang
Suhrcke, Marc
Millett, Christopher
author_role author
author2 Gonçalves, Judite
Seferidi, Paraskevi
Moreno-Serra, Rodrigo
Rocha, Rudi
Gupta, Indrani
Bhardwaj, Vinayak
Hidayat, Taufik
Cai, Chang
Suhrcke, Marc
Millett, Christopher
author2_role author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Escola Nacional de Saúde Pública (ENSP)
Centro de Investigação em Saúde Pública (CISP/PHRC)
Comprehensive Health Research Centre (CHRC) - Pólo ENSP
RUN
dc.contributor.author.fl_str_mv Hone, Thomas
Gonçalves, Judite
Seferidi, Paraskevi
Moreno-Serra, Rodrigo
Rocha, Rudi
Gupta, Indrani
Bhardwaj, Vinayak
Hidayat, Taufik
Cai, Chang
Suhrcke, Marc
Millett, Christopher
dc.subject.por.fl_str_mv Medicine(all)
SDG 3 - Good Health and Well-being
topic Medicine(all)
SDG 3 - Good Health and Well-being
description Funding Information: This research was funded by the UK National Institute for Health and Care Research (grant numbers NIHR133252 and NIHR150067) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the UK Department of Health and Social Care. Publisher Copyright: © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
publishDate 2024
dc.date.none.fl_str_mv 2024-06-13T00:33:24Z
2024-05
2024-05-01T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
format article
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10362/168505
url http://hdl.handle.net/10362/168505
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 2214-109X
PURE: 93225038
https://doi.org/10.1016/S2214-109X(24)00040-8
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
instname:FCCN, serviços digitais da FCT – Fundação para a Ciência e a Tecnologia
instacron:RCAAP
instname_str FCCN, serviços digitais da FCT – Fundação para a Ciência e a Tecnologia
instacron_str RCAAP
institution RCAAP
reponame_str Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
collection Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
repository.name.fl_str_mv Repositórios Científicos de Acesso Aberto de Portugal (RCAAP) - FCCN, serviços digitais da FCT – Fundação para a Ciência e a Tecnologia
repository.mail.fl_str_mv info@rcaap.pt
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