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The purpose of this paper is to develop a new approach to health service quality assurance.

Data were collected using a structured, eight-section questionnaire. Stratified random samples were drawn from four villages based in four Indian regions.

Psychological discomfort is an infant mortality rate (IMR) mediating factor. The root mean square error of approximation fit statistic for the model was 0.08, which was considered the best fit.

Addressing mediating causes can reduce IMR in developing countries.

The model that the authors described helps health institution managers to map quality assurance health management and economics.