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

BMC Public Health

Research Article

Orin S Levine¹  Jennifer C Moïsi²  Benjamin Tsofa³  Evasius Bauni⁴  Hellen Gatakaa⁴  Thomas N Williams⁵  J Anthony G Scott⁵  Abdisalan M Noor⁶ 

[1] Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya;District Medical Officer for Health, Kilifi, Kenya;KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya;KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya;Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford, UK;Malaria Public Health and Epidemiology Group, KEMRI/Wellcome Trust Research Programme, Nairobi, Kenya;

关键词: Health Facility;    Travel Time;    Child Mortality;    Physical Access;    Demographic Surveillance System;   

DOI  :  10.1186/1471-2458-10-142

 received in 2009-11-05, accepted in 2010-03-17,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundPolicy-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.MethodsThe 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.ResultsIn 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 two-fold 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.ConclusionsSignificant 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.

【 授权许可】

CC BY   
© Moïsi et al; licensee BioMed Central Ltd. 2010