title: Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam.
abstract: BACKGROUND
  Achieving a fair and equitable distribution of health in the population while progressing toward universal health coverage (UHC) is a key focus of health policy in Vietnam. This paper describes health barriers experienced by women (and children by inference) in Vietnam, and measures how UHC, with reference to maternal health services and child mortality rates, is affected by selected social determinants of health (SDH), termed 'barriers'.
  
  
  METHODS
  Our study uses a cross-sectional design with data from the 2011 Vietnam Multiple Indicator Cluster Survey. The study sample includes 11,663 women, aged 15-49 years. Weighted frequency statistics are cross-tabulated with socioeconomic characteristics of the population to describe the extent and distribution of health barriers experienced by disadvantaged women and children in Vietnam. A subset of women who had a live birth in the preceding two years (n=1,383) was studied to assess the impact of barriers to UHC and health. Six multiple logistic regressions were run using three dependent variables in the previous two years: 1) antenatal care, 2) skilled birth attendants, and 3) child death in the previous 15 years. Independent predictor variables were: 1) low education (incomplete secondary education), 2) lack of access to one of four basic amenities. In a second set of regressions, a constructed composite barrier index replaced these variables. Odds ratios (ORs) and 95% confidence intervals (95% CI) were used to report regression results.
  
  
  RESULTS
  In Vietnam, about 54% of women aged 15-49 years in 2011, had low education or lacked access to one of four basic amenities. About 38% of poor rural women from ethnic minorities experienced both barriers, compared with less than 1% of rich urban women from the ethnic majority. Incomplete secondary education or lack of one of four basic amenities was a factor significantly associated with lower access to skilled birth attendants (OR=0.28, 95% CI: 0.14-0.55; OR=0.19, 95% CI: 0.05-0.80) and a higher risk of having had a child death in the previous two years (OR=1.71, 95% CI: 1.28-2.30; OR=1.59, 95% CI: 1.20-2.10).
  
  
  CONCLUSIONS
  Our study shows the need for accelerating education and infrastructure investments for ethnic minority communities living in rural areas so as to be able to contribute to equity-oriented progress toward UHC.
authors: Hanoi School of Public Health, Hanoi, Vietnam; hvm@hsph.edu.vn.
authors: Hoang
authors: H
authors: Van Minh
authors: Department of Health Education, Hanoi Medical University, Hanoi, Vietnam.
authors: Kim Bao
authors: KB
authors: Giang
authors: Department of Biostatistics, Hanoi Medical University, Hanoi, Vietnam.
authors: Luu Ngoc
authors: LN
authors: Hoat
authors: Center for Health System Research, Hanoi Medical University, Hanoi, Vietnam.
authors: Le Hong
authors: le H
authors: Chung
authors: Department of International Cooperation, Ministry of Health, Hanoi, Vietnam.
authors: Tran Thi Giang
authors: TT
authors: Huong
authors: The World Health Organization, Hanoi, Vietnam.
authors: Nguyen Thi Kim
authors: NT
authors: Phuong
authors: Social Determinants of Health (SDH), Public Health, Environmental and Social Determinants of Health Department (PHE), World Health Organization, Geneva, Switzerland.
authors: Nicole B
authors: NB
authors: Valentine
mesh_terms: D000293:Adolescent; D000328:Adult; D046688:Child Mortality; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008427:Maternal Health Services / Q000706:statistics & numerical data / Q000600:supply & distribution*; D008875:Middle Aged; D011295:Prenatal Care / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D064890:Social Determinants of Health; D011795:Surveys and Questionnaires; D014744:Vietnam; D055815:Young Adult
keywords: education; equity; infrastructure; inter-sector; monitoring; universal health coverage