Social Determinants of Health and Health Inequities in Children Under-Five Years across Urban Slum and Rural Remote Areas of Sindh, Pakistan: A Qualitative Study

Khan GN, Majdzadeh R, Malekafzali H, Zaidi S

Background: Social determinants of health are responsible for obvious health inequities in children under five years of age between districts, rural-urban areas, regions, countries, and within countries. Reducing these health inequities requires urgent attention to the unfair distribution of power, money, resources and improving living conditions of urban slum and rural remote areas. The aim of this study was to explore social determinants of health and health inequities in children under-five years of age across urban slum and rural remote settings in the Province Sindh, Pakistan. Methods: We conducted 24 in-depth interviews (IDIs) with key informants and 12 focus group discussions (FGDs) with mothers and fathers of children under-five years of age and with government health workers across the two study settings. Results: Eight areas were identified which unevenly affect the health of the study population: (1) environmental factors; (2) sociocultural practices; (3) health care services; (4) economic factors; (5) political factors; (6) food insecurity; (7) early childhood development; and (8) access to child support programs. The most commonly cited social determinants were poverty, food insecurity, lack of health services and sociocultural practices in both urban slum and rural remote areas, while environmental pollution and poor sanitation conditions led to health inequities in urban slum areas. Conclusions: The study finding indicated that health inequities existed among children under-five years of age in the study area. Our results also indicated that in both study areas, children stand greater risk to be ill due to identified social determinants and inequities. This study supports the framework of Commission on Social Determinants of Health to explore environmental, sociocultural, economic, food insecurity, early childhood development, health care services and political culture as determinants of child health. Addressing these social determinants is very important through collaborative approaches with other sectors to reduce health inequities in children under-five years across urban slum and rural remote populations.

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