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Progress towards universal health coverage and inequalities in infant mortality

2024-05Artigo científico Acesso aberto
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dc.contributor.authorHone, Thomas
dc.contributor.authorGonçalves, Judite
dc.contributor.authorSeferidi, Paraskevi
dc.contributor.authorMoreno-Serra, Rodrigo
dc.contributor.authorRocha, Rudi
dc.contributor.authorGupta, Indrani
dc.contributor.authorBhardwaj, Vinayak
dc.contributor.authorHidayat, Taufik
dc.contributor.authorCai, Chang
dc.contributor.authorSuhrcke, Marc
dc.contributor.authorMillett, Christopher
dc.contributor.institutionEscola Nacional de Saúde Pública (ENSP)
dc.contributor.institutionCentro de Investigação em Saúde Pública (CISP/PHRC)
dc.contributor.institutionComprehensive Health Research Centre (CHRC) - Pólo ENSP
dc.contributor.pblElsevier
dc.date.accessioned2024-06-13T00:33:24Z
dc.date.available2024-06-13T00:33:24Z
dc.date.issued2024-05
dc.descriptionFunding 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
dc.description.abstractBackground: 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.en
dc.description.versionpublishersversion
dc.description.versionpublished
dc.format.extent1960545
dc.identifier.doi10.1016/S2214-109X(24)00040-8
dc.identifier.issn2214-109X
dc.identifier.otherPURE: 93225038
dc.identifier.otherPURE UUID: 09a5eddb-445d-444b-a925-d310ea6f563f
dc.identifier.otherScopus: 85189977438
dc.identifier.otherPubMed: 38614628
dc.identifier.otherWOS: 001228340900001
dc.identifier.urihttp://hdl.handle.net/10362/168505
dc.identifier.urlhttps://www.scopus.com/pages/publications/85189977438
dc.language.isoeng
dc.peerreviewedyes
dc.subjectGeneral Medicine
dc.subjectSDG 3 - Good Health and Well-being
dc.titleProgress towards universal health coverage and inequalities in infant mortalityen
dc.title.subtitlean analysis of 4·1 million births from 60 low-income and middle-income countries between 2000 and 2019en
dc.typejournal article
degois.publication.firstPagee744
degois.publication.issue5
degois.publication.lastPagee755
degois.publication.titleThe Lancet Global Health
degois.publication.volume12
dspace.entity.typePublication
rcaap.rightsopenAccess

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