Dominant factors affecting regional inequality of infant mortality in Vietnam: A structural equation modelling analysis

Abstract

Background: Despite Vietnam’s acclaiming achievements of reducing overall infant mortality rate (IMR), the IMR decline does not occur equally in all regions in Vietnam. This study aims to investigate dominant factors that affect the inequality of infant mortality across regions in Vietnam during the period 2005-2015. Methods: We use nationally representative data to construct a panel data of 6 economic regions in Vietnam from 2005 to 2015. We employ the structural equation modelling (SEM) approach to quantify the causal effect of socio-economic status (SES), accessing to skilled birth attendance (SBA) and other relevant factors on the disparity of IMR across regions. Results: SES, which is measured by 3 indicators – illiteracy rate (IR), poverty rate (PR) and income per capita – is the dominant factor causing regional inequalities of infant mortality, followed by the use of SBA. Among these indicators, the PR is the most important one causing the regional disparity of IMR and accessing to SBA. The total effect of SES on infant mortality disparity is 2.6 times as high as that of accessing skilled healthcare personnel. Conclusion: Bridging the regional gap of using skilled health personnel would contribute to improving the infant mortality inequality in Vietnam. This inequality, however, is not significantly improved only with medical interventions but also with broader and more comprehensive socio-economic interventions at both national and regional levels. Our findings confirm that poverty reduction and growth strategies should be the main focus to boost medical interventions and improve IMR all over the country.