TITLE

Geographic access to care is not a determinant of child mortality in a rural Kenyan setting with high health facility density

AUTHOR(S)
Moïsi, Jennifer C.; Gatakaa, Hellen; Noor, Abdisalan M; Williams, Thomas N.; Bauni, Evasius; Tsofa, Benjamin; Levine, Orin S.; Scott, J. Anthony G.
PUB. DATE
January 2010
SOURCE
BMC Public Health;2010, Vol. 10, p142
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: Policy-makers evaluating country progress towards the Millennium Development Goals also examine trends in health inequities. Distance to health facilities is a known determinant of health care utilization and may drive inequalities in health outcomes; we aimed to investigate its effects on childhood mortality. Methods: The Epidemiological and Demographic Surveillance System in Kilifi District, Kenya, collects data on vital events and migrations in a population of 220,000 people. We used Geographic Information Systems to estimate pedestrian and vehicular travel times to hospitals and vaccine clinics and developed proportional-hazards models to evaluate the effects of travel time on mortality hazard in children less than 5 years of age, accounting for sex, ethnic group, maternal education, migrant status, rainfall and calendar time. Results: In 2004-6, under-5 and under-1 mortality ratios were 65 and 46 per 1,000 live-births, respectively. Median pedestrian and vehicular travel times to hospital were 193 min (inter-quartile range: 125-267) and 49 min (32-72); analogous values for vaccine clinics were 47 (25-73) and 26 min (13-40). Infant and under-5 mortality varied twofold across geographic locations, ranging from 34.5 to 61.9 per 1000 child-years and 8.8 to 18.1 per 1000, respectively. However, distance to health facilities was not associated with mortality. Hazard Ratios (HR) were 0.99 (95% CI 0.95-1.04) per hour and 1.01 (95% CI 0.95-1.08) per half-hour of pedestrian and vehicular travel to hospital, respectively, and 1.00 (95% CI 0.99-1.04) and 0.97 (95% CI 0.92-1.05) per quarter-hour of pedestrian and vehicular travel to vaccine clinics in children <5 years of age. Conclusions: Significant spatial variations in mortality were observed across the area, but were not correlated with distance to health facilities. We conclude that given the present density of health facilities in Kenya, geographic access to curative services does not influence population-level mortality.
ACCESSION #
49164171

 

Related Articles

  • Low Child Survival Index in a Multi-Dimensionally Poor Amerindian Population in Venezuela. Villalba, Julian A.; Liu, Yushi; Alvarez, Mauyuri K.; Calderon, Luisana; Canache, Merari; Cardenas, Gaudymar; Del Nogal, Berenice; Takiff, Howard E.; De Waard, Jacobus H. // PLoS ONE;Dec2013, Vol. 8 Issue 12, p1 

    Background:Warao Amerindians, who inhabit the Orinoco Delta, are the second largest indigenous group in Venezuela. High Warao general mortality rates were mentioned in a limited study 21 years ago. However, there have been no comprehensive studies addressing child survival across the entire...

  • EDITOR'S CHOICE. Let's talk shit. Godlee, Fiona // BMJ: British Medical Journal (Overseas & Retired Doctors Edition;9/18/2010, Vol. 341 Issue 7773, preceding p563 

    An introduction to several reports discussed within the issue is presented, including an article by Peter Moszynski on inequities on medical care, an article on sanitation by Rebecca Coombes and an editorial by Joy Lawn on the growing problem of children's mortality.

  • Change and persistence in healthcare inequities: Access to elective surgery in Finland in 1992-2003. Manderbacka, Kristiina; Arffman, Martti; Leyland, Alastair; McCallum, Alison; Keskimäki, Ilmo // Scandinavian Journal of Public Health;Mar2009, Vol. 37 Issue 2, p131 

    Aims: Many countries experience persistent or increasing socioeconomic disparities in specialist care. This study examines the socioeconomic distribution of elective surgery from 1992 to 2003 in Finland. Methods: Administrative registers were used to identify common elective procedures performed...

  • Barriers to healthcare utilization in fatiguing illness: a population-based study in Georgia. Lin, Jin-Mann S.; Brimmer, Dana J.; Boneva, Roumiana S.; Jones, James F.; Reeves, William C. // BMC Health Services Research;2009, Vol. 9, Special section p1 

    Background: The purpose of this study was to determine the prevalence of barriers to healthcare utilization in persons with fatiguing illness and describe its association with socio-demographics, the number of health conditions, and frequency of healthcare utilization. Furthermore, we sought to...

  • Variation in the Ecology of Medical Care. Fryer Jr., George F.; Green, Larry A.; Dovey, Susan M.; Yawn, Barbara P; Phillips, Robert L.; Lanier, David // Annals of Family Medicine;Jul2003, Vol. 1 Issue 2, p81 

    Reports on the variation in the medical care delivery with the sociodemographic characteristics and health care arrangements of individual person in the U.S. Link between people and the health care environment; Differences in health care persons with health insurance and source of care;...

  • Desigualdades sociodemográficas e causas de morte em menores de cinco anos no Estado de Pernambuco. Murakami, Gabriela Ferraz; Bezerra Guimarães, Maria José; Sarinho, Silvia Wanick // Revista Brasileira de Saude Materno Infantil;abr-jun2011, Vol. 11 Issue 2, p139 

    OBJECTIVES: to characterize mortality in children aged under five years in the three-year period, 2004-2006, identifying sociodemographic inequalities and differences in the cause of death among the sub-regions of the State of Pernambuco. METHODS: a cross-sectional study was carried out of 6721...

  • Impact of Treatment Success on Health Service Use and Cost in Depression: Longitudinal Database Analysis. Byford, Sarah; Barrett, Barbara; Despiégel, Nicolas; Wade, Alan // PharmacoEconomics;2011, Vol. 29 Issue 2, p157 

    Background: Research has consistently demonstrated a relationship between depression and increased levels of health service use over the short term. However, much less is known about how this relationship is influenced by the success, or otherwise, of depression management strategies, and the...

  • Prevalence of mental distress and use of health services in a rural district in Vietnam. Kim Bao Giang; Truong Viet Dzung; Kullgren, Gunnar; Allebeck, Peter // Global Health Action;2010, Vol. 3, p1 

    Aims: The aims were to estimate the prevalence of mental distress in different socio-demographic groups; and to analyze use of health care services among persons reporting mental distress. Methods: Face-to-face interviews with the Self-Reporting Questionnaires (SRQ-20) were conducted in a sample...

  • Changes Not for the Fainthearted: Reorienting Health Care Systems Toward Health Equity Through Action on the Social Determinants of Health. Baum, Fran E.; Bégin, Monique; Houweling, Tanja A. J.; Taylor, Sebastian // American Journal of Public Health;Nov2009, Vol. 99 Issue 11, p1967 

    Entrenched poor health and health inequity are important public health problems. Conventionally, solutions to such problems originate from the health care sector, a conception reinforced by the dominant biomedical imagination of health. By contrast, attention to the social determinants of health...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics