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Service Quality beyond Access: A Multilevel Analysis of Neonatal, Infant, and Under-Five Child Mortality Using the Indian Demographic and Health Survey 2015~2016

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dc.contributor.authorKim, Rockli-
dc.contributor.authorChoi, Narshil-
dc.contributor.authorSubramanian, S. V.-
dc.contributor.authorOh, Juhwan-
dc.date.accessioned2018-11-05T02:40:54Z-
dc.date.available2018-11-05T02:40:54Z-
dc.date.issued2018-10-
dc.identifier.citationPerspectives in Nursing Science, Vol.15 No.2, pp. 49-49-
dc.identifier.issn2288-2898-
dc.identifier.urihttps://hdl.handle.net/10371/142955-
dc.description.abstractPurpose: The purpose of this study was to derive contextual indicators of medical provider quality and assess their relative importance along with the individual utilization of antenatal care (ANC) and institutional births with a skilled birth attendant (SBA) in India using a multilevel framework. Methods: The 2015~2016 Demographic and Health Survey (DHS) from India was used to assess the outcomes of neonatal, infant, and under-five child mortality. The final analytic sample included 182,980 children across 28,283 communities, 640 districts, and 36 states and union territories. The contextual indicators of medical provider quality for districts and states were derived from the individual-level number of ANC visits (<4 or≥4) and institutional delivery with SBA. A series of random effects logistic regression models were estimated with a stepwise addition of predictor variables. Results: About half of the mothers (47.3%) had attended≥4 ANC visits and 75.8% delivered in institutional settings with SBAs. Based on ANC visits, 276~281 districts (43.1~43.9%) and 13~16 states (36.5~44.4%) were classified as low quality areas, whereas 268~285 districts (41.9~44.5%) and 8~9 states (22.2~25.0%) were classified as low quality areas based on institutional delivery with SBAs. Conditional on a comprehensive set of covariates, the individual use of both ANC and SBA were significantly associated with all mortality outcomes (OR: 1.17, 95% CI: 1.08, 1.26, and OR: 1.10, 95% CI: 1.02, 1.19, respectively, for under-five child mortality) and remained robust even after adjusting for contextual indicators of medical provider quality. Districts and states with low quality were associated with 57~61% and 27~43% higher odds of under-five child mortality, respectively. Conclusion: When simultaneously considered, district- and state-level provider quality mattered more than individual access to care for all mortality outcomes in India. Further investigations are needed to assess the importance of improving the quality of health service delivery at higher levels to prevent unnecessary child deaths in developing countries.-
dc.language.isoen-
dc.publisher서울대학교 간호과학연구소-
dc.subjectAntenatal care-
dc.subjectProvider quality-
dc.subjectChild mortality-
dc.subjectIndia-
dc.subjectMultilevel analysis-
dc.titleService Quality beyond Access: A Multilevel Analysis of Neonatal, Infant, and Under-Five Child Mortality Using the Indian Demographic and Health Survey 2015~2016-
dc.typeSNU Journal-
dc.contributor.AlternativeAuthor김록리-
dc.contributor.AlternativeAuthor최나실-
dc.contributor.AlternativeAuthor오주환-
dc.identifier.doi10.16952/pns.2018.15.2.49-
dc.citation.journaltitlePerspectives in Nursing Science(간호학의 지평)-
dc.citation.endpage49-
dc.citation.number2-
dc.citation.pages49-49-
dc.citation.startpage49-
dc.citation.volume15-
Appears in Collections:
College of Nursing (간호대학)The Research Institute of Nursing Science (간호과학연구소)Perspectives in Nursing Science (간호학의 지평, PNS)Perspectives In Nursing Science (간호학의 지평) Volume 15 Number 1-2(2018)
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