Distance to care, care seeking and child mortality in rural Burkina Faso: findings from a population‐based cross‐sectional survey

Abstract

Objective Although distance has been identified as an important barrier to care, evidence for an effect of distance to care on child mortality is inconsistent. We investigated the association of distance to care with self‐reported care seeking behaviours, neonatal and post‐neonatal under‐five child mortality in rural areas of Burkina Faso. Methods We performed a cross‐sectional survey in 14 rural areas from November 2014 to March 2015. About 100 000 women were interviewed on their pregnancy history and about 5000 mothers were interviewed on their care seeking behaviours. Euclidean distances to the closest facility were calculated. Mixed‐effects logistic and Poisson regressions were used respectively to compute odds ratios for care seeking behaviours and rate ratios for child mortality during the 5 years prior to the survey. Results Thirty per cent of the children lived more than 7 km from a facility. After controlling for confounding factors, there was a strong evidence of a decreasing trend in care seeking with increasing distance to care ( P ≤ 0.005). There was evidence for an increasing trend in early neonatal mortality with increasing distance to care ( P = 0.028), but not for late neonatal mortality ( P = 0.479) and post‐neonatal under‐five child mortality ( P = 0.488). In their first week of life, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility ( RR = 1.18; 95% CI 1.00, 1.39; P = 0.056). In the late neonatal period, despite the lack of evidence for an association of mortality with distance, it is noteworthy that rate ratios were consistent with a trend and similar to or larger than estimates in early neonatal mortality. In this period, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility ( RR = 1.18; 95% CI 0.92, 1.52; P = 0.202). Thus, the lack of evidence may reflect lower power due to fewer deaths rather than a weaker association. Conclusion While better geographic access to care is strongly associated with increased care seeking in rural Burkina Faso, the impact on child mortality appears to be marginal. This suggests that, in addition to improving access to services, attention needs to be paid to quality of those services.

The Profile, Health Seeking Behavior, Referral Patterns, and Outcome of Outborn Neonates Admitted to a District and Regional Hospital in the Upper West Region of Ghana: A Cross-Sectional Study

“…Proximity, the main determinant of the choice of a health facility, has been reported as an important determinant of care by other studies [7,10,12,23,30]. However, in spite of visiting a health facility, the majority of these outborns neonates did not receive any treatment prior to the referral.…”

Relationship between symptoms, barriers to care and healthcare utilisation among children under five in rural Mali

“…Our findings related to the effects of distance and wealth on care utilisation for children under five are consistent with previous studies. Across settings, wealthier households are more likely to seek any, timely and appropriate care [ 31 , 32 , 33 , 34 , 35 , 36 ], and distance to a healthcare facility is inversely related to the frequency and timeliness of care utilisation [ 37 , 38 , 39 ].…”

Condiciones en la frontera sur entre Colombia y Venezuela ante la pandemia de COVID-19

“…Los cálculos de acceso geográfico permitieron presentar de manera sintética los grandes retos en caso de penetración de la pandemia, con tiempos medianos de acceso a atención médica de entre 11,9 y 16,1 horas en el río Inírida, o entre 8,7 y 12,3 en el rio Guainía (frontera), que no garantizan oportunidad en la atención en caso de una urgencia respiratoria, como la producida por COVID-19. En áreas remotas hay que garantizar estrategias que reduzcan el riesgo de enfermar y morir (12), pues su probabilidad aumenta cuando se está lejos de los sitios de atención (13), cuando se vive en zonas rurales (14,15) o lejos de un hospital, en el caso de la mortalidad materna y perinatal (16); asimismo, los menores de cinco años corren un gran riesgo si viven a más de 5 km del centro de atención (17), este es el caso de la neumonía (18) y el de otras causas respiratorias (19); lo mismo sucede al vivir a más de 7 km, hecho que aumenta la probabilidad de la mortalidad neonatal temprana (20) o al vivir a más de 80 km, en el caso de la mortalidad neonatal (21).…”