Barriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 data.

backgroundAccess to healthcare involves timely and affordable service availability. Barriers, such as economic and geographic factors, particularly affect low- and middle-income countries. This study analyzes the spatial distribution and socio-economic determinants of healthcare access barriers among female youths in Mozambique to inform targeted interventions.

methodsData from the Mozambique Demographic and Health Survey (DHS) 2022/23 on maternal and child health was analyzed. Using a stratified two-stage sampling design, 619 enumeration areas were selected, including 5,743 female youths aged 15-24. Barriers were assessed based on finances, distance, permission, and safety, with independent variables like age, education, wealth index, marital status, and community factors. Analyses included multilevel logistic regression and spatial methods (Global Moran's I, SaTScan) using Stata 17 and ArcGIS 10.7 to identify barriers and clusters.

resultsThis study found that 49.10% (95% CI: 47.81%, 50.39%) of female youths reported barriers to healthcare access, primarily due to financial difficulties (40.69%) and distance (38.16%). Youths aged 20-24 were 15% lower odds of facing barriers (AOR = 0.85, 95% CI: 0.73, 0.99). Those with no formal education were 2.18 times more likely to face barriers (AOR = 2.18, 95% CI: 1.22, 3.88). Youths from poor and middle-wealth households were 1.9 times (AOR = 1.9, 95% CI: 1.44, 2.49) and 1.51 times (AOR = 1.51, 95% CI: 1.19, 1.92) more likely to face barriers, respectively. Married youths had a 1.22 times higher likelihood of facing barriers (AOR = 1.22, 95% CI: 1.03, 1.44), and rural residents were three times more likely to experience challenges compared to urban residents (AOR = 3.00, 95% CI: 2.24, 4.01). Spatial analysis revealed regional disparities, with hotspots in Southern Manica and Northern Zambezia.

conclusionsFemale youths in Mozambique face significant barriers to healthcare access, mainly due to financial constraints and distance, with regional concentrations in Southern Manica, Southern Niassa, and Northern Zambezia. Key determinants include age, education, marital status, rural residency, and economic status. Targeted interventions should address these disparities by enhancing economic opportunities, promoting education, and improving transportation infrastructure. Policymakers must prioritize strategies to advance gender equity and health outcomes for female youths in Mozambique.