Broader and more inclusive interventions required to improve child health

Parents’ education and mothers’ autonomy to decide about children’s health are among the factors associated with child mortality in Bangladesh, a new icddr,b study has found.

The study recommends that such social factors, which are not directly related to health, should also be taken into account when designing health-related interventions, to reduce the number of infant and child deaths and inequalities in death rates across society.

In Bangladesh, government prioritised reducing disparities in child health . Photo: GMB Akashicddr,b

Called the social determinants of health (SDH), these social factors were found to have complex relationship and interactions with child mortality. “The SDH are the circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness,” observes Dr Tanvir M. Huda, principal investigator of the study published in Global Health Action and a project coordinator at icddr,b.

The SDH gained more attention after the Commission on Social Determinants of Health (CSDH) was established by the WHO in 2005 to support countries and global health partners in addressing the social factors leading to ill health and health inequities.

In Bangladesh, reducing disparities in child health and mortality has been a government priority. Despite considerable progress in child health, these disparities remain challenges to be tackled.


Social risk factors

The icddr,b study found that key SDH such as mother’s age, the education of both parents, the mother’s autonomy to take decisions about matters linked to the health of her child, household socio-economic conditions, geographical region of residence, and the condition of local roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh.

“These associations indicate that to improve the health of the population and reduce health inequalities, it is crucial we take into account the role of SDH on health outcomes and disease and design our interventions accordingly,” says Dr Huda.

“Also since Universal Health Coverage (UHC) has been acknowledged as a priority goal, more people are realising the importance of social determinants of health in realising equity-oriented UHC,” adds Dr Huda.

The WHO defines UHC as a means through which all people receive the health services they need without suffering financial hardship when paying for them. It suggests that the full spectrum of essential, quality health services should be covered including health promotion, prevention and treatment, rehabilitation and palliative care.


Cross-sector partnering

New treatments and preventive measures such as vaccines clearly have an important role to play in improving child health. However, as health is affected by many factors outside the health sector, looking at health issues from a narrow perspective may mean important determinants of health are neglected.

“Much larger intersectoral actions and social participation are needed for more effective interventions,” emphasises Dr Huda.

Dr Shams El Arifeen, senior director, maternal & child health at icddr,b, and co-author of the study, observes that achieving optimum health outcome and reducing health inequalities will therefore require broader and more inclusive cross-sectoral interventions, with health policymakers playing a key leadership role.

To back up their work, evidence is needed to better understand the role and contribution of SDH, particularly to Bangladesh – this icddr,b analysis being a prime example in the area of child health, he says.