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Title: A study on social determinants of infant mortality in Malaysia
Author: Ahmad, A.
ISNI:       0000 0004 2713 392X
Awarding Body: University of Warwick
Current Institution: University of Warwick
Date of Award: 2011
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1.1 Background There is a large body of empirical evidence to suggest that social conditions are one of the major determinants of population health. These are defined as the ‘Social determinants of Health (SDH)’. SDH refers to the specific pathways by which social forces affect health. Developing a better understanding of the social determinants of health is critical in order to ameliorate the social determinants associated with poor health and to reduce the health disparities within the population. 1.2 Aim To examine the relationship between social determinants and infant mortality in Malaysia 1.3 Methods This study comprises an ecological (area-based) population health survey involving all 135 administrative districts of Malaysia. A literature review was undertaken in order to develop a model that hypothesises the main social determinants of infant mortality in Malaysia. In order to test the model, secondary data comprises of social determinants and infant mortality rate data from a range of sources were collected and analysed. Statistical analysis of the data using general linear model including correlations, factor analysis and multiple regression were undertaken in order to examine the collective influence of a range of social determinants on variations observed in infant mortality. Determinants of infant mortality in Malaysia tested in this study include GDP per capita, poverty rate, mean income of bottom 40% income earner, Gini coefficient, ratio of top 20% income: to bottom 40% income, doctors density ratio, hospital bed per population ratio, car ownership per population, computer ownership per population, urbanization rate, percentage living in single housing and flats, women education and social development index. 1.4 Results Although simple regression revealed significant relation between IMR with fifteen predictors, further analysis using multiple regressions failed to demonstrate any significant linear relationship except cars per population ratio which may reflect accessibility to food and services. This phenomenon may be due to problem of multicolinearity among variables. Factor analysis was done to identify similar items and new variables were created based on the identified factors. With the new group of variables, social development index explained 18%, income distribution explained 10.6% and health service provision explained 3.8 % of the variability observed in IMR. However, with multiple regressions, only social development index remained significant at p<0.05 level. Collectively, the variables were able to explain only 23% of the variability in IMR using multiple linear regressions analysis. 1.5 Conclusion This study managed to inform us regarding the important social determinants that can be altered with policy change in order to improve child survival in a developing country undergoing its health and economic transitions.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: RA Public aspects of medicine