Analysis of selected social determinants of health and their relationships with maternal health service coverage and child mortality in Vietnam

Figures & data

Table 1 Sociodemographic characteristics of the study sample of mothers aged 15–49 years: frequency, unweighted, and weighted percentages (n=11,663)

Characteristics	Frequency	Unweighted percentage	Weighted percentage
Age
15–19	1,443	12.4	12.4
20–24	1,654	14.2	13.9
25–29	1,638	14.0	14.2
30–34	1,741	14.9	15.5
35–39	1,789	15.3	15.5
40–44	1,629	14.0	13.7
45–49	1,769	15.2	14.7
Education
None	612	5.3	3.8
Primary	1,883	16.2	16.0
Lower secondary	4,244	36.4	38.8
Upper secondary	2,830	24.3	24.8
Tertiary	2,094	18.0	16.6
Ethnicity
Ethnic minority	1,827	15.7	10.4
Kinh	9,836	84.3	89.6
Living area
Rural	6,480	55.6	67.4
Urban	5,183	44.4	32.6
Economic status (asset-based wealth index quintile)
Poorest	2,152	18.5	16.9
Second	1,924	16.5	18.5
Middle	2,222	19.1	20.8
Fourth	2,529	21.7	21.5
Richest	2,836	24.3	22.3
Total	11,663	100	100

Fig. 1 The percentage of Vietnamese women, aged 15–49 years, experiencing one or more barriers to health (n=11,663). Low maternal education: if a woman aged 15–49 years had not completed secondary education. Lack of access to basic infrastructure and amenities: if a woman aged 15–49 years was living in a household which had no access to at least one of the four basic amenities – (a) safe energy, (b) safe water, (c) sanitation, or (d) safe energy for cooking.

Table 2 The frequency of health barriers experienced by women aged 15–49 years stratified according to key characteristics (n=11,663)

	Low maternal education^a (%)	Lack of access to basic infrastructure and amenities^b (%)	Had either barrier (%)	Had both barriers (%)
Living area
Rural	15.0*	64.7*	67.1*	12.6*
Urban	7.1	22.6	26.2	3.6
Ethnicity
Ethnic minority	33.7*	92.2*	93.4*	32.5*
Kinh	10.0	46.2	49.1	7.0
Economic status (asset-based wealth index quintile)
Poorest	29.9*	99.7*	99.7*	29.9*
Second	16.0	91.7	92.6	14.9
Middle	11.5	59.9	63.8	7.6
Fourth	7.2	17.6	23.8	1.1
Richest	2.2	4.4	6.5	0.1
Total	12.4	51.0	53.8	9.6

*Statistical significance: p<0.05, chi-squared test.

^aLow maternal education: if a woman aged 15–49 years had not completed secondary education; ^black of access to basic infrastructure and amenities: if a woman aged 15–49 years is living in a household which has no access to at least one of the four basic amenities – (a) safe energy, (b) safe water, (c) sanitation, or (d) safe energy for cooking.

Table 3 Distribution of the health barriers cross-tabulated with two population sub-groups defined by intersecting aspects of socioeconomic status (n=11,663)

	Health barrier
Sub-group defined by intersecting aspects of socioeconomic status	Low maternal education (incomplete secondary education)^a (%)	Lack of access to basic infrastructure and amenities^b (%)	Had either barrier (%)	Had both barriers (%)
Rural, ethnicity minority and poorest	38.2*	99.6*	99.6*	38.2*
Urban, Kinh and richest	2.0	4.4	6.3	0.1
Total	12.4	51.0	53.8	9.6
Gap in absolute percentage points	36.2	94.8	93.3	38.1

*Statistical significance: p<0.05, chi-squared test.

^aLow maternal education: if a woman aged 15–49 years had not completed secondary education; ^black of access to basic infrastructure and amenities: if a woman aged 15–49 years is living in a household which has no access to at least one of the four basic amenities – (a) safe energy, (b) safe water, (c) sanitation, or (d) safe energy for cooking.

Table 4 Odds ratios for three multiple logistic regressions of low maternal education and lack of access to basic infrastructure and amenities on antenatal healthcare, skilled birth attendants, and child death

	Dependent variables^a
	Antenatal care (among women who had a live birth in the preceding 2 years) (n=1,265)		Skilled birth attendants (among women who had a live birth in the preceding 2 years) (n=1,362)		Child death (women who had a deceased child in the previous 15 years) (n=11,657)
Independent variables^b	Odds ratio^c	95% CI	Odds ratio^c	95% CI	Odds ratio^c	95% CI
Low maternal education (incomplete secondary education)
Yes	0.66	0.43–1.01	0.28*	0.14–0.55	1.71*	1.28–2.3
No	1	1	1	1	1	1
Lack of access to basic infrastructure and amenities
Yes	0.57*	0.39–0.82	0.19*	0.05–0.8	1.59*	1.2–2.1
No	1	1	1	1	1	1

*Statistical significance: p<0.05 level, chi-square test.

^aDependent variables included: 1) antenatal care (yes=1 if a mother aged 15–49 years, who gave birth in the previous 2 years, had four or more antenatal visits, no=0 otherwise); 2) skilled birth attendants (yes=1 if the latest delivery was attended by a health professional, no=0 otherwise); and 3) child death (yes=1 if a mother had a child dead, no=0 otherwise); ^bindependent variables included: 1) low maternal education (yes=1 if a mother aged 15–49 years, who gave birth in the previous 2 years, or who had had a child who died in the previous 15 years, had not completed secondary education; 2) lack of access to basic infrastructure and amenities if a household has no access to at least one of the four basic amenities (a) safe energy, (b) safe water, (c) sanitation, (d) safe energy for cooking; and other potential confounders (age, living area, ethnicity, and economic status of the women); ^codds ratios are adjusted for age, living area, ethnicity, and economic status of the women.

Table 5 Odds ratios for three multiple logistic regressions of the composite barrier index on maternal healthcare, skilled birth attendants, and child death

	Dependent variables^a
	Antenatal care (among women who had a live birth in the preceding 2 years) (n=1,265)		Skilled birth attendants (among women who had a live birth in the preceding 2 years) (n=1,362)		Child death (women who had a deceased child in the previous 15 years) (n=11,657)
Independent variables^b	Odds ratio^c	95% CI	Odds ratio^c	95% CI	Odds ratio^c	95% CI
Composite index^c
Had both barriers	0.39*	0.23–0.66	0.06*	0.01–0.29	2.71*	1.87–3.92
Had either barrier	0.58*	0.39–0.87	0.56	0.11–2.78	1.6*	1.19–2.18
No barrier	1	1	1	1	1	1
p values for log likelihood ratio tests comparing the model using the composite barrier index and the one using the two separate barriers	p>0.05		p>0.05		p>0.05

*Statistical significance: p<0.05 level, chi-square test.

^aDependent variables included: 1) antenatal care (yes=1 if a mother had four or more antenatal visits, no=0 otherwise); 2) skilled birth attendants (yes=1 if the latest delivery was attended by a health professional, no=0 otherwise); and 3) child death (yes=1 if a mother had a child dead, no=0 otherwise); ^bindependent variables included: 1) composite index (both barriers=1 if women had incomplete secondary education and lack of access to at least one of the four basic amenities, had either barrier=2 if women had either barrier, or no barrier=0; the composite index was included as substitutes for the two separate barrier variables); and other potential confounders (age, living area, ethnicity, and economic status of the women); ^c odds ratios are adjusted for age, living area, ethnicity, and economic status of the women.