Effect of healthcare spending on the relationship between the Human Development Index and maternal and neonatal mortality

Background: Several factors affect morbidity and mortality the world over. Previous research shows mortality rates are higher among individuals of lower socio-economic status. We investigated the trajectory of neonatal (NM) and maternal (MM) mortality between 2010 and 2014 and the effect of healthcare spending on the relationship between the Human Development Index (HDI) and NM and MM. Methods: Data were obtained from the United Nations Development Program and World Bank. Latent growth curve models (LGCMs) were estimated to determine the trajectory of NM and MM across the study period and the effect of the HDI on NM and MM. Mediation analysis was used to determine if healthcare expenditure mediated the relationship between HDI and NM and MM rates. ArcGIS (Esri, Redlands, CA, USA) was used to generate a choropleth map of changes in NM and MM between 2010 and 2014. Findings: Results showed many countries in Africa enjoyed decreases in NM and MM between 2010 and 2014, but other countries (Algeria, Libya and Sudan) showed little or no improvement. The LGCM for NM (Comparative Fit Index=0.956) and MM (CFI=0.963) demonstrated good fit to the data and showed that the HDI was negatively related to NM and MM. Mediation analysis showed that healthcare spending mediated the relationship between NM and MM in each year. Conclusions: Given that healthcare spending can mediate the relationship between HDI and NM and MM, increases in healthcare spending among countries with low HDI could improve NM and MM outcomes.