The effect of distance to health-care facilities on childhood mortality in rural Burkina Faso

TY - JOUR

T1 - The effect of distance to health-care facilities on childhood mortality in rural Burkina Faso

AU - Schoeps, Anja

AU - Gabrysch, Sabine

AU - Niamba, Louis

AU - Sié, Ali

AU - Becher, Heiko

PY - 2011/3/1

Y1 - 2011/3/1

N2 - This study aims to investigate the relation between distance to health facilities, measured as continuous travel time, and mortality among infants and children younger than 5 years of age in rural Burkina Faso, an area with low health facility density. The study included 24,555 children born between 1993 and 2005 in the Nouna Health and Demographic Surveillance System. The average walking time from each village to the closest health facility was obtained for both the dry and the rainy season, and its effect on infant (<1 year), child (1-4 years), and under-5 mortality overall was analyzed by Cox regression. The authors observed 3,426 childhood deaths, corresponding to a 5-year survival of 85%. Walking distance was significantly related to both infant and child mortality, although the shape of this effect varied distinctly between the 2 age groups. Overall, under-5 mortality, adjusted for confounding, was more than 50% higher at a distance of 4 hours compared with having a health facility in the village (P < 0.0001, 2 sided). The region of residence was an additional determinant for under-5 mortality. The findings of this study emphasize the importance of geographic accessibility of health care for child survival in sub-Saharan Africa and demonstrate the need to improve health-care access to achieve the Millennium Development Goals.

AB - This study aims to investigate the relation between distance to health facilities, measured as continuous travel time, and mortality among infants and children younger than 5 years of age in rural Burkina Faso, an area with low health facility density. The study included 24,555 children born between 1993 and 2005 in the Nouna Health and Demographic Surveillance System. The average walking time from each village to the closest health facility was obtained for both the dry and the rainy season, and its effect on infant (<1 year), child (1-4 years), and under-5 mortality overall was analyzed by Cox regression. The authors observed 3,426 childhood deaths, corresponding to a 5-year survival of 85%. Walking distance was significantly related to both infant and child mortality, although the shape of this effect varied distinctly between the 2 age groups. Overall, under-5 mortality, adjusted for confounding, was more than 50% higher at a distance of 4 hours compared with having a health facility in the village (P < 0.0001, 2 sided). The region of residence was an additional determinant for under-5 mortality. The findings of this study emphasize the importance of geographic accessibility of health care for child survival in sub-Saharan Africa and demonstrate the need to improve health-care access to achieve the Millennium Development Goals.

KW - Burkina Faso

KW - Child

KW - Child Mortality

KW - Child, Preschool

KW - Developing Countries

KW - Health Facilities

KW - Health Services Accessibility

KW - Humans

KW - Infant

KW - Infant Mortality

KW - Infant, Newborn

KW - Population Surveillance

KW - Proportional Hazards Models

KW - Risk Factors

KW - Rural Population

U2 - 10.1093/aje/kwq386

DO - 10.1093/aje/kwq386

M3 - SCORING: Journal article

C2 - 21262911

VL - 173

SP - 492

EP - 498

JO - AM J EPIDEMIOL

JF - AM J EPIDEMIOL

SN - 0002-9262

IS - 5

ER -