Faculty of Public Health, Khon Kaen University, Khon Kaen.
Geospat Health. 2023 Aug 31;18(2). doi: 10.4081/gh.2023.1220.
Under-5 mortality rate (U5MR) is a key indicator of child health and overall development. In Thailand, despite significant steps made in child health, disparities in U5MR persist across different provinces. We examined various socio-economic variables, health service availability and environmental factors impacting U5MR in Thailand to model their influences through spatial analysis. Global and Local Moran's I statistics for spatial autocorrelation of U5MR and its related factors were used on secondary data from the Ministry of Public Health, National Centers for Environmental Information, National Statistical Office, and the Office of the National Economic and Social Development Council in Thailand. The relationships between U5MR and these factors were modelled using ordinary least squares (OLS) estimation, spatial lag model (SLM) and spatial error model (SEM). There were significant spatial disparities in U5MR across Thailand. Factors such as low birth weight, unemployment rate, and proportion of land use for agricultural purposes exhibited significant positive spatial autocorrelation, directly influencing U5MR, while average years of education, community organizations, number of beds for inpatients per 1,000 population, and exclusive breastfeeding practices acted as protective factors against U5MR (R2 of SEM = 0.588).The findings underscore the need for comprehensive, multi-sectoral strategies to address the U5MR disparities in Thailand. Policy interventions should consider improving socioeconomic conditions, healthcare quality, health accessibility, and environmental health in high U5M areas. Overall, this study provides valuable insights into the spatial distribution of U5MR and its associated factors, which highlights the need for tailored and localized health policies and interventions.
5 岁以下儿童死亡率（U5MR）是儿童健康和整体发展的关键指标。在泰国，尽管在儿童健康方面取得了重大进展，但不同省份之间 U5MR 的差异仍然存在。我们研究了各种社会经济变量、卫生服务的可及性以及影响泰国 U5MR 的环境因素，通过空间分析来模拟它们的影响。使用来自泰国公共卫生部、国家环境信息中心、国家统计局和国家经济社会发展委员会办公室的二级数据，对 U5MR 及其相关因素进行全局和局部 Moran's I 统计的空间自相关分析。使用普通最小二乘法（OLS）估计、空间滞后模型（SLM）和空间误差模型（SEM）来模拟 U5MR 与这些因素之间的关系。泰国各地的 U5MR 存在显著的空间差异。低出生体重、失业率和农业用途土地比例等因素表现出显著的正空间自相关，直接影响 U5MR，而平均受教育年限、社区组织、每千人口住院床位数和纯母乳喂养做法则是 U5MR 的保护因素（SEM 的 R2 为 0.588）。研究结果强调了泰国需要采取全面的、多部门的策略来解决 U5MR 差异问题。政策干预措施应考虑改善高 U5MR 地区的社会经济条件、医疗质量、卫生可及性和环境卫生。总的来说，这项研究提供了关于 U5MR 及其相关因素的空间分布的宝贵见解，这突出了制定有针对性和本地化的卫生政策和干预措施的必要性。
