LAUSR

Background: Under-five mortality is unacceptably high in Bangladesh instead of governmental level efforts to reduce its prevalence over the years. Increased availability and access to the healthcare services can play a significant role to reduce under-five mortality. We explored the associations of several forms of child mortality with health facility level factors adjusted for individual-, household-, and community level factors. Methods: The 2017-18 Bangladesh Demographic and Health Survey data and 2017 Bangladesh Health Facility Survey data were linked and analysed. Our outcome variables were neonatal mortality, infant mortality, and under-five mortality. Health facility level factors were considered as major explanatory variables. They were the basic management and administrative system of the healthcare facility, availability of the child healthcare services at the nearest healthcare facility, readiness of the nearest healthcare facility to provide child healthcare services and the average distance of the nearest healthcare facility providing child healthcare services. The associations between the outcome variables and explanatory variables were determined using the multilevel mixed-effect logistic regression model. Results: Reported under-five, infant and neonatal mortality were 40, 27, and 22 per 10000 live births, respectively. The likelihood of neonatal mortality was found to be declined by 15% for every unit increase in the score of the basic management and administrative system of the mothers homes nearest healthcare facility where child healthcare services are available. Similarly, the availability and readiness of the mothers homes nearest healthcare facilities to provide child healthcare services were found to be linked with the 18-24% reduction in neonatal and infant mortality. On contrary, for every kilometre increased distance between mothers homes and their nearest healthcare facility was found to be associated with a 15-20% increase in the likelihoods of neonatal, infant and under-five mortality. Conclusion The availability of health facilities providing child healthcare services close to residence and their improved management, infrastructure, and readiness to provide child healthcare services play a significant role in reducing under-five mortality in Bangladesh. Policies and programs should prioritize to increase the availability and accessibility of health facilities that provide child healthcare services.