title: The importance of intersectoral factors in promoting equity-oriented universal health coverage: a multilevel analysis of social determinants affecting neonatal infant and under-five mortality in Bangladesh.
abstract: BACKGROUND
  Health is multidimensional and affected by a wide range of factors, many of which are outside the health sector. To improve population health and reduce health inequality, it is important that we take into account the complex interactions among social, environmental, behavioural, and biological factors and design our health interventions accordingly.
  
  
  OBJECTIVE
  This study examines mortality differentials in children of different age groups by key social determinants of health (SDH) including parental education and employment, mother's level of autonomy, age, asset index, living arrangements (utilities), and other geographical contextual factors (area of residence, road conditions).
  
  
  METHODS
  We used data from the two rounds of Bangladesh Health and Demographic Survey, a nationally representative sample survey of the population residing in Bangladesh. Multilevel logistic models were used to study the impact of SDH on child mortality.
  
  
  RESULTS
  The study found that the mother's age, the education of both parents, the mother's autonomy to take decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh.
  
  
  CONCLUSIONS
  The study findings suggest there are complex relationships among different SDH. Thus larger intersectoral actions will be needed to reduce disparities in child health and mortality and achieve meaningful progress towards equity-oriented universal health coverage.
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, Australia.|Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh; huda.tanvir@gmail.com; thuda@icddrb.org.
authors.forename: Tanvir M
authors.initials: TM
authors.lastname: Huda
authors.affiliation: Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh.
authors.forename: Tazeen
authors.initials: T
authors.lastname: Tahsina
authors.affiliation: Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh.
authors.forename: Shams
authors.initials: S
authors.lastname: El Arifeen
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Dibley
mesh_terms: D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D046688:Child Mortality; D002675:Child, Preschool; D003710:Demography; D005260:Female; D062306:Geography, Medical; D054624:Health Status Disparities; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D009035:Mothers / Q000706:statistics & numerical data; D055361:Multilevel Analysis; D012307:Risk Factors; D064890:Social Determinants of Health; D012959:Socioeconomic Factors; D019472:Universal Health Insurance
keywords: Bangladesh; health inequality; inequality; inequity; infant mortality; intersectoral action; neonatal mortality; social determinants of health; under-five mortality; universal health coverage