Determinants of performance of health systems concerning maternal and child health: a global approach.
<h4>Aims</h4>To assess the association of social determinants on the performance of health systems around the world.<h4>Methods</h4>A transnational ecological study was conducted with an observation level focused on the country. In order to research on the strength of the ass...
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Public Library of Science (PLoS)
2015-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0120747 |
| _version_ | 1819140222303076352 |
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| author | Carlos Eduardo Pinzón-Flórez Julián Alfredo Fernández-Niño Myriam Ruiz-Rodríguez Álvaro J Idrovo Abel Armando Arredondo López |
| author_facet | Carlos Eduardo Pinzón-Flórez Julián Alfredo Fernández-Niño Myriam Ruiz-Rodríguez Álvaro J Idrovo Abel Armando Arredondo López |
| author_sort | Carlos Eduardo Pinzón-Flórez |
| collection | DOAJ |
| description | <h4>Aims</h4>To assess the association of social determinants on the performance of health systems around the world.<h4>Methods</h4>A transnational ecological study was conducted with an observation level focused on the country. In order to research on the strength of the association between the annual maternal and child mortality in 154 countries and social determinants: corruption, democratization, income inequality and cultural fragmentation, we used a mixed linear regression model for repeated measures with random intercepts and a conglomerate-based geographical analysis, between 2000 and 2010.<h4>Results</h4>Health determinants with a significant association on child mortality(<1year): higher access to water (βa Quartile 4(Q4) vs Quartile 1(Q1) = -6,14; 95%CI: -11,63 to -0,73), sanitation systems, (Q4 vs Q1 = -25,58; 95%CI: -31,91 to -19,25), % measles vaccination coverage (Q4 vs Q1 = -7.35; 95%CI: -10,18 to -4,52), % of births attended by a healthcare professional (Q4 vs Q1 = -7,91; 95%CI: -11,36 to -4,52) and a % of the total health expenditure (Q3 vs Q1 = -2,85; 95%CI: -4,93 to -0,7). Ethnic fragmentation (Q4 vs Q1 = 9,93; 95%CI: -0.03 to 19.89) had a marginal effect. For child mortality<5 years, an association was found for these variables and democratization (not free vs free = 11,23; 95%CI: -0,82 to 23,29), out-of-pocket expenditure (Q1 vs Q4 = 17,71; 95%CI: 5,86 to 29,56). For MMR (Maternal mortality ratio), % of access to water for all the quartiles, % of access to sanitation systems, (Q3 vs Q1 = -171,15; 95%CI: -281,29 to -61), birth attention by a healthcare professional (Q4 vs Q1 = -231,23; 95%CI: -349,32 to -113,15), and having corrupt government (Q3 vs Q1 = 83,05; 95%CI: 33,10 to 133).<h4>Conclusions</h4>Improving access to water and sanitation systems, decreasing corruption in the health sector must become priorities in health systems. The ethno-linguistic cultural fragmentation and the detriment of democracy turn out to be two factors related to health results. |
| first_indexed | 2024-12-22T11:35:07Z |
| format | Article |
| id | doaj.art-e80f772bc2ab414d985b255ee8c72faa |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-22T11:35:07Z |
| publishDate | 2015-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj.art-e80f772bc2ab414d985b255ee8c72faa2022-12-21T18:27:28ZengPublic Library of Science (PLoS)PLoS ONE1932-62032015-01-01103e012074710.1371/journal.pone.0120747Determinants of performance of health systems concerning maternal and child health: a global approach.Carlos Eduardo Pinzón-FlórezJulián Alfredo Fernández-NiñoMyriam Ruiz-RodríguezÁlvaro J IdrovoAbel Armando Arredondo López<h4>Aims</h4>To assess the association of social determinants on the performance of health systems around the world.<h4>Methods</h4>A transnational ecological study was conducted with an observation level focused on the country. In order to research on the strength of the association between the annual maternal and child mortality in 154 countries and social determinants: corruption, democratization, income inequality and cultural fragmentation, we used a mixed linear regression model for repeated measures with random intercepts and a conglomerate-based geographical analysis, between 2000 and 2010.<h4>Results</h4>Health determinants with a significant association on child mortality(<1year): higher access to water (βa Quartile 4(Q4) vs Quartile 1(Q1) = -6,14; 95%CI: -11,63 to -0,73), sanitation systems, (Q4 vs Q1 = -25,58; 95%CI: -31,91 to -19,25), % measles vaccination coverage (Q4 vs Q1 = -7.35; 95%CI: -10,18 to -4,52), % of births attended by a healthcare professional (Q4 vs Q1 = -7,91; 95%CI: -11,36 to -4,52) and a % of the total health expenditure (Q3 vs Q1 = -2,85; 95%CI: -4,93 to -0,7). Ethnic fragmentation (Q4 vs Q1 = 9,93; 95%CI: -0.03 to 19.89) had a marginal effect. For child mortality<5 years, an association was found for these variables and democratization (not free vs free = 11,23; 95%CI: -0,82 to 23,29), out-of-pocket expenditure (Q1 vs Q4 = 17,71; 95%CI: 5,86 to 29,56). For MMR (Maternal mortality ratio), % of access to water for all the quartiles, % of access to sanitation systems, (Q3 vs Q1 = -171,15; 95%CI: -281,29 to -61), birth attention by a healthcare professional (Q4 vs Q1 = -231,23; 95%CI: -349,32 to -113,15), and having corrupt government (Q3 vs Q1 = 83,05; 95%CI: 33,10 to 133).<h4>Conclusions</h4>Improving access to water and sanitation systems, decreasing corruption in the health sector must become priorities in health systems. The ethno-linguistic cultural fragmentation and the detriment of democracy turn out to be two factors related to health results.https://doi.org/10.1371/journal.pone.0120747 |
| spellingShingle | Carlos Eduardo Pinzón-Flórez Julián Alfredo Fernández-Niño Myriam Ruiz-Rodríguez Álvaro J Idrovo Abel Armando Arredondo López Determinants of performance of health systems concerning maternal and child health: a global approach. PLoS ONE |
| title | Determinants of performance of health systems concerning maternal and child health: a global approach. |
| title_full | Determinants of performance of health systems concerning maternal and child health: a global approach. |
| title_fullStr | Determinants of performance of health systems concerning maternal and child health: a global approach. |
| title_full_unstemmed | Determinants of performance of health systems concerning maternal and child health: a global approach. |
| title_short | Determinants of performance of health systems concerning maternal and child health: a global approach. |
| title_sort | determinants of performance of health systems concerning maternal and child health a global approach |
| url | https://doi.org/10.1371/journal.pone.0120747 |
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