Availability and readiness of health care facilities and their effects on under-five mortality in Bangladesh: Analysis of linked data.

Background: Under-five mortality is unacceptably high in Bangladesh instead of governmental level efforts to reduce its prevalence over the years. Increased availability and accessibility to the health care facility and its services can play a significant role to reduce its occurrence. We explored the associations of several forms of child mortality with health facility level factors. Methods: The 2017-18 Bangladesh Demographic and Health Survey (BDHS) data and 2017 Bangladesh Health Facility Survey (BHFS) data were linked and analysed. The outcome variables were neonatal mortality, infant mortality, and under-five mortality. Health facility level factors were considered as major explanatory variables. They were the basic management and administrative system of the nearest health care facility where child health care services are available, degree of availability of the child health care services at the nearest health care facility, degree of readiness of the nearest health care facility (where child health care services are available) to provide child health care services and average distance of the nearest health care facility from mothers' homes where child health care services are available. The associations between the outcome variables and explanatory variables were determined using the multilevel mixed-effect logistic regression model. Results: Reported under-five, infant and neonatal mortality were 40, 27, and 22 per 10 000 live births, respectively. The likelihood of neonatal mortality was found to be declined by 15% for every unit increase in the score of the basic management and administrative system of the mothers' homes nearest health care facility where child health care services are available. Similarly, degree of availability and readiness of the mothers' homes nearest health care facilities to provide child health care services were found to be linked with 18%-24% reduction in neonatal and infant mortality. On contrary, for every kilometre increased distance between mothers' homes and its nearest health care facility was found to be associated with a 15%-20% increase in the likelihoods of neonatal, infant and under-five mortality. Conclusions: The availability of health facilities providing child health care services close to mothers' residence and its readiness to provide child health care services play a significant role in reducing under-five mortality in Bangladesh. Policies and programs should be taken to increase the availability and accessibility of health facilities that provide child health care services.