Correction: Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study

Treacy, Laura; Bolkan, Håkon A.; Sagbakken, Mette

doi:10.1371/journal.pone.0196523

Cited by 8 publications

(4 citation statements)

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“…In our study, these differences can partly be attributed to socio-economic differences in rural and urban areas in Sierra Leone. 46,47 In rural areas, mainly maternal factors of stunting status, age, and education were significantly associated with childhood stunting compared to parity and paternal education in urban areas. The strong impact of these maternal factors on rural children's stunting is mostly multifaceted.…”

Section: Discussionmentioning

confidence: 98%

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Rural and Urban Correlates of Stunting Among Under-Five Children in Sierra Leone: A 2019 Nationwide Cross-Sectional Survey

Sserwanja¹,

Kamara

Mutisya

et al. 2021

Nutr Metab Insights

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Background: Undernutrition accounts for at least 50% of the annual global under-five mortality burden. Although disparities in the childhood stunting between urban and rural areas in Sierra Leone have been documented, information on factors associated with these differences is lacking. We aimed to determine rural-urban correlates of stunting among children under the age of 5 in Sierra Leone. Methods: We analyzed data from 2019 Sierra Leone demographic and health survey (SLDHS) focusing on under-five children. We conducted multivariable logistic regression to examine rural-urban factors associated with childhood stunting. Results: Prevalence of stunting was 31.6% (95% CI 29.8-33.2) in rural areas and 24.0% (95% CI 21.6-26.1) in urban areas. Within the rural areas, children of stunted mothers (aOR = 2.37; 95% CI 1.07-5.24, P < .05), younger mothers aged 15 to 19 years (aOR = 2.08; 95% CI 1.17-3.69, P < .05), uneducated mothers (aOR = 1.87; 95% CI 1.28-2.71, P < .01), as well as older children (24-59 months) (aOR = 1.83; 95% CI 1.48-2.27, P < .001), and boys (aOR = 1.37; 95% CI 1.12-1.66, P < .01) were more likely to be stunted compared to those of non-stunted, older, post-primary education mothers and those who were less than 24 months and girls respectively. While urban children whose fathers had lower education (aOR = 1.94; 95% CI 1.10-3.42, P < .05), whose mothers were more parous (para 2-4) (aOR = 1.74; 95% CI 1.03-2.95, P < .05), and boys (aOR = 1.48; 95% CI 1.06-2.08, P < .05) were more likely to be stunted compared to their counterparts with fathers that had tertiary education, mothers of low parity and girls, respectively. Conclusions: Stunting is more prevalent in the rural areas compared to the urban areas. Sex of the child was the only significant factor in both rural and urban areas. Our study findings suggest that programs designed to reduce stunting should aim for integrated yet context specific interventions in rural and urban areas.

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Section: Discussionmentioning

confidence: 98%

“…In our study, these differences can partly be attributed to socio-economic differences in rural and urban areas in Sierra Leone. 46 , 47 …”

Section: Discussionmentioning

confidence: 99%

Rural and Urban Correlates of Stunting Among Under-Five Children in Sierra Leone: A 2019 Nationwide Cross-Sectional Survey

Sserwanja¹,

Kamara

Mutisya

et al. 2021

Nutr Metab Insights

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“…In general, after nearly half a century of development, the research on the fairness of medical and health services has made great progress. These studies covered country level, community level, and city level (4)(5)(6), including various fields such as the balance of medical resource allocation, the fairness of medical services, and the accessibility of medical facilities (7)(8)(9), and the research objects involved developed or developing countries such as Canada, the United States, Spain, Italy, Argentina, India, etc. (10)(11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Spatial distribution, regional differences, and dynamic evolution of the medical and health services supply in China

Chen

Jin

2022

Front. Public Health

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The imbalance of medical and health services supply (MHSS) is a significant public health concern as regional economic development disparities widen in China. Based on the provincial panel data of medical and health services, this paper constructed an evaluation index system and used the two-stage nested entropy method to measure the MHSS level of 31 provinces in China from 2005 to 2020. Then we used the standard deviation ellipse, Dagum Gini coefficient, β convergence model, kernel density estimation and Markov chain to investigate the spatial distribution, regional differences, and dynamic evolution of MHSS. According to the results of these analysis, the conclusions are drawn as follows: (1) In general, the MHSS level in China showed a significant up-ward trend from 2005 to 2020. However, the MHSS level among different provinces showed a non-equilibrium characteristic. (2) Regional comparison shows that the eastern region had the highest level, and the central region had the lowest level. The eastern and central regions presented polarization, while the western region showed unremarkable gradient effect. (3) During the period, the overall regional differences, intra-regional differences, and inter-regional differences of MHSS level all showed convergence. (4) The economic development, urbanization rate, fiscal self-sufficiency rate, and foreign direct investment had significant impacts on the convergence. (5) The provinces with high levels had the positive spillover effect. The findings of this paper provide theoretical supports for optimizing the allocation of health resources and improving the equity of MHSS.

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“…Although healthcare service utilization rates among pregnant women increased after the implementation of FHCI, this improvement was deemed not adequate enough to meet the sustainable development goals of the country [ 7 , 24 , 25 ]. Indeed, the FHCI had to face a number of issues hampering its effectiveness, first and foremost the non-affordability of transport-related indirect costs for people residing in rural areas [ 7 , 26 , 27 ] Moreover, the decision to seek care in health facilities during childbirth in rural Sierra Leone is also affected by a number of cultural and sociodemographic factors that often limit the impact of public health initiatives [ 26 , 28 ]. Although it is argued that the sole availability of EMS does not equal access to care when barriers related to the social acceptability of the initiatives are not fully addressed [ 29 ], our findings suggest that the development of a nationwide referral system (e.g., NEMS) may be a key strategy to boost the effects of other healthcare interventions already in place.…”

Section: Discussionmentioning

confidence: 99%

Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service

Caviglia

Dell'Aringa

Putoto

et al. 2021

IJERPH

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We aim to evaluate whether the first National Emergency Medical Service (NEMS) improved access to hospital care for the people of Sierra Leone. We performed an interrupted time-series analysis to assess the effects of NEMS implementation on hospital admissions in 25 facilities. The analysis was also replicated separately for the area of Freetown and the rest of the country. The study population was stratified by the main Free Health Care Initiative (FHCI) categories of pregnant women, children under 5 years of age, and populations excluded from the FHCI. Finally, we calculated direct costs of the service. We report a 43% overall increase in hospital admissions immediately after NEMS inception (RR 1.43; 95% CI 1.2–1.61). Analyses stratified by FHCI categories showed a significant increase among pregnant women (RR 1.54; 95% CI 1.33–1.77) and among individuals excluded from the FHCI (RR 2.95; 95% CI 2.47–3.53). The observed effect was mainly due to the impact of NEMS on the rural districts. The estimated recurrent cost per ambulance ride and NEMS yearly cost per inhabitant were 124 and 0.45 USD, respectively. To our knowledge, this is the first nationwide study documenting the increase in access to healthcare services following the implementation of an ambulance-based medical service in a low-income country. Based on our results, NEMS was able to overcome the existing barriers of geographical accessibility and transport availability, especially in the rural areas of Sierra Leone.

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Correction: Distance, accessibility and costs. Decision-making during childbirth in rural Sierra Leone: A qualitative study

Cited by 8 publications

References 1 publication

Rural and Urban Correlates of Stunting Among Under-Five Children in Sierra Leone: A 2019 Nationwide Cross-Sectional Survey

Rural and Urban Correlates of Stunting Among Under-Five Children in Sierra Leone: A 2019 Nationwide Cross-Sectional Survey

Spatial distribution, regional differences, and dynamic evolution of the medical and health services supply in China

Improving Access to Healthcare in Sierra Leone: The Role of the Newly Developed National Emergency Medical Service

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