Barriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 data

Abstract Background Access to healthcare involves timely and affordable service availability. Barriers, such as economic and geographic factors, particularly affect low- and middle-income countries. This study analyzes the spatial distribution and socio-economic determinants of healthcare access bar...

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Main Authors: Habtu Kifle Negash, Hiwot Tezera Endale, Hailu Aragie, Winta Tesfaye, Mihret Getnet, Tseganesh Asefa, Yibeltal Yismaw Gela, Alebachew Ferede Zegeye
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Language:English
Published: BMC 2025-02-01
Series:BMC Public Health
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Online Access:https://doi.org/10.1186/s12889-025-21690-y
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author Habtu Kifle Negash
Hiwot Tezera Endale
Hailu Aragie
Winta Tesfaye
Mihret Getnet
Tseganesh Asefa
Yibeltal Yismaw Gela
Alebachew Ferede Zegeye
author_facet Habtu Kifle Negash
Hiwot Tezera Endale
Hailu Aragie
Winta Tesfaye
Mihret Getnet
Tseganesh Asefa
Yibeltal Yismaw Gela
Alebachew Ferede Zegeye
author_sort Habtu Kifle Negash
collection DOAJ
description Abstract Background Access to healthcare involves timely and affordable service availability. Barriers, such as economic and geographic factors, particularly affect low- and middle-income countries. This study analyzes the spatial distribution and socio-economic determinants of healthcare access barriers among female youths in Mozambique to inform targeted interventions. Methods Data from the Mozambique Demographic and Health Survey (DHS) 2022/23 on maternal and child health was analyzed. Using a stratified two-stage sampling design, 619 enumeration areas were selected, including 5,743 female youths aged 15–24. Barriers were assessed based on finances, distance, permission, and safety, with independent variables like age, education, wealth index, marital status, and community factors. Analyses included multilevel logistic regression and spatial methods (Global Moran’s I, SaTScan) using Stata 17 and ArcGIS 10.7 to identify barriers and clusters. Results This study found that 49.10% (95% CI: 47.81%, 50.39%) of female youths reported barriers to healthcare access, primarily due to financial difficulties (40.69%) and distance (38.16%). Youths aged 20–24 were 15% lower odds of facing barriers (AOR = 0.85, 95% CI: 0.73, 0.99). Those with no formal education were 2.18 times more likely to face barriers (AOR = 2.18, 95% CI: 1.22, 3.88). Youths from poor and middle-wealth households were 1.9 times (AOR = 1.9, 95% CI: 1.44, 2.49) and 1.51 times (AOR = 1.51, 95% CI: 1.19, 1.92) more likely to face barriers, respectively. Married youths had a 1.22 times higher likelihood of facing barriers (AOR = 1.22, 95% CI: 1.03, 1.44), and rural residents were three times more likely to experience challenges compared to urban residents (AOR = 3.00, 95% CI: 2.24, 4.01). Spatial analysis revealed regional disparities, with hotspots in Southern Manica and Northern Zambezia. Conclusions Female youths in Mozambique face significant barriers to healthcare access, mainly due to financial constraints and distance, with regional concentrations in Southern Manica, Southern Niassa, and Northern Zambezia. Key determinants include age, education, marital status, rural residency, and economic status. Targeted interventions should address these disparities by enhancing economic opportunities, promoting education, and improving transportation infrastructure. Policymakers must prioritize strategies to advance gender equity and health outcomes for female youths in Mozambique.
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spelling doaj-art-549cee84b7814ec6978a640e740e5a3a2025-02-09T12:58:02ZengBMCBMC Public Health1471-24582025-02-0125111410.1186/s12889-025-21690-yBarriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 dataHabtu Kifle Negash0Hiwot Tezera Endale1Hailu Aragie2Winta Tesfaye3Mihret Getnet4Tseganesh Asefa5Yibeltal Yismaw Gela6Alebachew Ferede Zegeye7Department of Anatomy, School of Medicine, College of Medicine and Health Sciences, University of GondarDepartment of Medical Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of GondarDepartment of Anatomy, School of Medicine, College of Medicine and Health Sciences, University of GondarDepartment of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of GondarDepartment of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of GondarDepartment of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of GondarDepartment of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of GondarDepartment of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of GondarAbstract Background Access to healthcare involves timely and affordable service availability. Barriers, such as economic and geographic factors, particularly affect low- and middle-income countries. This study analyzes the spatial distribution and socio-economic determinants of healthcare access barriers among female youths in Mozambique to inform targeted interventions. Methods Data from the Mozambique Demographic and Health Survey (DHS) 2022/23 on maternal and child health was analyzed. Using a stratified two-stage sampling design, 619 enumeration areas were selected, including 5,743 female youths aged 15–24. Barriers were assessed based on finances, distance, permission, and safety, with independent variables like age, education, wealth index, marital status, and community factors. Analyses included multilevel logistic regression and spatial methods (Global Moran’s I, SaTScan) using Stata 17 and ArcGIS 10.7 to identify barriers and clusters. Results This study found that 49.10% (95% CI: 47.81%, 50.39%) of female youths reported barriers to healthcare access, primarily due to financial difficulties (40.69%) and distance (38.16%). Youths aged 20–24 were 15% lower odds of facing barriers (AOR = 0.85, 95% CI: 0.73, 0.99). Those with no formal education were 2.18 times more likely to face barriers (AOR = 2.18, 95% CI: 1.22, 3.88). Youths from poor and middle-wealth households were 1.9 times (AOR = 1.9, 95% CI: 1.44, 2.49) and 1.51 times (AOR = 1.51, 95% CI: 1.19, 1.92) more likely to face barriers, respectively. Married youths had a 1.22 times higher likelihood of facing barriers (AOR = 1.22, 95% CI: 1.03, 1.44), and rural residents were three times more likely to experience challenges compared to urban residents (AOR = 3.00, 95% CI: 2.24, 4.01). Spatial analysis revealed regional disparities, with hotspots in Southern Manica and Northern Zambezia. Conclusions Female youths in Mozambique face significant barriers to healthcare access, mainly due to financial constraints and distance, with regional concentrations in Southern Manica, Southern Niassa, and Northern Zambezia. Key determinants include age, education, marital status, rural residency, and economic status. Targeted interventions should address these disparities by enhancing economic opportunities, promoting education, and improving transportation infrastructure. Policymakers must prioritize strategies to advance gender equity and health outcomes for female youths in Mozambique.https://doi.org/10.1186/s12889-025-21690-yBarriers to healthcareFemale youthsHealthcare accessMozambique
spellingShingle Habtu Kifle Negash
Hiwot Tezera Endale
Hailu Aragie
Winta Tesfaye
Mihret Getnet
Tseganesh Asefa
Yibeltal Yismaw Gela
Alebachew Ferede Zegeye
Barriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 data
BMC Public Health
Barriers to healthcare
Female youths
Healthcare access
Mozambique
title Barriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 data
title_full Barriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 data
title_fullStr Barriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 data
title_full_unstemmed Barriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 data
title_short Barriers to healthcare access among female youths in Mozambique: a mixed-effects and spatial analysis using DHS 2022/23 data
title_sort barriers to healthcare access among female youths in mozambique a mixed effects and spatial analysis using dhs 2022 23 data
topic Barriers to healthcare
Female youths
Healthcare access
Mozambique
url https://doi.org/10.1186/s12889-025-21690-y
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