Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis

Okwaraji, Yemisrach B.; Edmond, Karen

doi:10.1136/bmjopen-2012-001196

Cited by 45 publications

(50 citation statements)

References 34 publications

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“…A partir de la evidencia disponible a la fecha, Okwaraji y Edmond, en 2012, reportaron que el riesgo podría ser entre 23% y 63% mayor [19]. De forma similar, en este estudio se estimaron medidas resumen mayores que en el metaanálisis de Okwaraji y Edmond para los subgrupos de mortalidad infantil, riesgo al menos 16% mayor, y de mortalidad en la niñez, riesgo al menos 29% mayor.…”

Section: Discussionunclassified

“…De forma similar, en este estudio se estimaron medidas resumen mayores que en el metaanálisis de Okwaraji y Edmond para los subgrupos de mortalidad infantil, riesgo al menos 16% mayor, y de mortalidad en la niñez, riesgo al menos 29% mayor. Por el contrario, para el periodo neonatal con la inclusión de dos nuevos estudios realizados en Madagascar y Etiopia se obtiene una medida resumen máximo 96% mayor, en comparación con la estimación de exceso en 172% reportada por Okwaraji y Edmond [19].…”

Section: Discussionunclassified

“…Los artículos fueron obtenidos de dos fuentes: las revisiones sistemáticas anteriores [18,19] Criterios de inclusión: i) artículo original; ii) con los términos de búsqueda en el título, resumen y/o palabras clave; iii) publicación en español, inglés o portugués; iv) con diseño observacional, y v) con reporte de la medida de asociación.…”

Section: Estrategia De Búsquedaunclassified

“…Para la estimación de la medida resumen de asociación en el grupo de mortalidad perinatal, no se incluyeron nuevos artículos, por lo cual se obtuvo el mismo resultado reportado por Okwaraji y Edmond [19] km: kilometro; m: milla; min; minuto; n: tamaño de la muestra; *: días persona; --: no reportado; N/A: no aplica.…”

Section: Metaanálisisunclassified

“…Posteriormente, en 2012, Okwaraji y Edmond [19] publicaron la segunda revisión sistemática sobre distancia y mortalidad en menores de 5 años, extendiéndose a países de bajo y mediano ingreso. Estos autores incluyeron 20 artículos en la revisión sistemática y, a partir de 13 de estos, realizaron un metaanálisis que los llevó a concluir que el riesgo de mortalidad es significativamente mayor (OR 1,42; IC95% 1,23-1,63) entre los niños que viven a más de 5 km de distancia del centro de salud, comparado con los niños que viven más cerca.…”

Section: Introductionunclassified

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Distancia al centro de atención en salud y mortalidad durante los primeros años de vida: revisión sistemática y metaanálisis

Rojas‐Gualdrón

Velasquez

2017

Rev. Fac. Nac. Salud Pública

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Resumen Objetivo: actualizar las revisiones sistemáticas sobre el efecto de la distancia a los centros de atención en salud, en la mortalidad de menores de 5 años, con artículos publicados hasta mayo de 2015. Metodología: revisión sistemática con metaanálisis según recomendaciones de PRISMA. Se estimó un modelo de efectos aleatorios y se realizaron análisis de sesgo y de heterogeneidad de las estimaciones. Resultados: residir a más de 5 km del centro de atención de salud se asocia con un mayor riesgo de muerte en los periodos perinatal OR 2,76 (IC95% 1,80 -4,23), neonatal OR 1,62 (IC95% 1,33-1,96), infantil OR 1,31 (IC95% 1,16-1,48), durante la niñez OR 1,57 (IC95% 1,29-1,92) y en todos los grupos de edad OR 1,63 (IC95% 1,41-1,88). Conclusión: se resalta la importancia de considerar una distribución geográfica de los centros de atención en salud, que permita a los menores residentes en áreas remotas menores riesgos de muerte, particularmente durante el primer mes de vida.----------Palabras clave: accesibilidad a los servicios de salud, disparidades en atención de salud, área sin atención médica, mortalidad infantil, metaanálisis. AbstractObjective: to update the systematic reviews of the literature discussing the effect of the distance from healthcare facilities on the mortality of children under five years of age using academic papers up to May, 2015. Methodology: a systematic review of the literature and a meta-analysis conducted in accordance with the PRISMA guidelines. A random effect model was estimated and bias and heterogeneity analyses were conducted on the estimates. Results: residing farther than 5 km away from the closest healthcare facility is associated with a greater risk of death during the following periods: perinatal OR 2.76

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Section: Discussionunclassified

Section: Estrategia De Búsquedaunclassified

Section: Metaanálisisunclassified

Section: Introductionunclassified

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Distancia al centro de atención en salud y mortalidad durante los primeros años de vida: revisión sistemática y metaanálisis

Rojas‐Gualdrón

Velasquez

2017

Rev. Fac. Nac. Salud Pública

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Distance to Health Centers and Effectiveness of Azithromycin Mass Administration for Children in Niger

Chao,

Arzika,

Abdou

et al. 2023

JAMA Netw Open

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ImportanceThe MORDOR (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) trial demonstrated that mass azithromycin administration reduced mortality by 18% among children aged 1 to 59 months in Niger. The identification of high-risk subgroups to target with this intervention could reduce the risk of antimicrobial resistance.ObjectiveTo evaluate whether distance to the nearest primary health center modifies the effect of azithromycin administration to children aged 1 to 59 months on child mortality.Design, Setting, and ParticipantsThe MORDOR cluster randomized trial was conducted from December 1, 2014, to July 31, 2017; this post hoc secondary analysis was conducted in 2023 among 594 clusters (communities or grappes) in the Boboye and Loga departments in Niger. All children aged 1 to 59 months in eligible communities were evaluated.InterventionsBiannual (twice-yearly) administration of a single dose of oral azithromycin or matching placebo over 2 years.Main Outcomes and MeasuresA population-based census was used to monitor mortality and person-time at risk (trial primary outcome). Community distance to a primary health center was calculated as kilometers between the center of each community and the nearest health center. Negative binomial regression was used to evaluate the interaction between distance and the effect of azithromycin on the incidence of all-cause mortality among children aged 1 to 59 months.ResultsBetween December 1, 2014, and July 31, 2017, a total of 594 communities were enrolled, with 76 092 children (mean [SD] age, 31 [2] months; 39 022 [51.3%] male) included at baseline, for a mean (SD) of 128 (91) children per community. Median (IQR) distance to the nearest primary health center was 5.0 (3.2-7.1) km. Over 2 years, 145 693 person-years at risk were monitored and 3615 deaths were recorded. Overall, mortality rates were 27.5 deaths (95% CI, 26.2-28.7 deaths) per 1000 person-years at risk in the placebo arm and 22.5 deaths (95% CI, 21.4-23.5 deaths) per 1000 person-years at risk in the azithromycin arm. For each kilometer increase in distance in the placebo arm, mortality increased by 5% (adjusted incidence rate ratio, 1.05; 95% CI, 1.03-1.07; P &lt; .001). The effect of azithromycin on mortality varied significantly by distance (interaction P = .02). Mortality reduction with azithromycin compared with placebo was 0% at 0 km from the health center (95% CI, −19% to 17%), 4% at 1 km (95% CI, −12% to 17%), 16% at 5 km (95% CI, 7% to 23%), and 28% at 10 km (95% CI, 17% to 38%).Conclusions and RelevanceIn this secondary analysis of a cluster randomized trial of mass azithromycin administration for child mortality, children younger than 5 years who lived farthest from health facilities appeared to benefit the most from azithromycin administration. These findings may help guide the allocation of resources to ensure that those with the least access to existing health resources are prioritized in program implementation.Trial RegistrationClinicalTrials.gov Identifier: NCT02047981

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Predictors of Health Care Seeking Behavior During Pregnancy, Delivery, and the Postnatal Period in Rural Tanzania

Larsen

Exavery

Phillips

et al. 2016

Matern Child Health J

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Objectives Four antenatal visits, delivery in a health facility, and three postnatal visits are the World Health Organization recommendations for women to optimize maternal health outcomes. This study examines maternal compliance with the full recommended maternal health visits in rural Tanzania with the goal of illuminating interventions to reduce inequalities in maternal health. Methods Analysis included 907 women who had given birth within two years preceding a survey of women of reproductive age. Multinomial logistic regression was used to assess the influence of maternal, household, and community-level characteristics on four alternative classes defining relative compliance with optimal configuration of maternal health care seeking behavior. Results Parity, wealth index, timeliness of ANC initiation, nearest health facility type, religion, and district of residence were significant predictors of maternal health care seeking when adjusted for other factors. Multiparous women compared to primiparous were less likely to seek care at the high level [RRR 0.16, 95 % confidence interval (CI) 0.06-0.46], at the mid-level (RRR 0.22, 95 % CI 0.09-0.58), and the mid-low level (RRR 0.27, 95 % CI 0.09-0.80). Women in the highest wealth index compared to those in the poorest group were almost three times more likely to seek the highest two levels of care versus the lowest level (high RRR 2.92, 95 % CI 1.27-6.71, mid-level RRR 2.71, 95 % 1.31-5.62). Conclusion Results suggest that efforts to improve the overall impact of services on the continuum of care in rural Tanzania would derive particular benefit from strategies that improve maternal health coverage among multiparous and low socioeconomic status women.

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Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis

Cited by 45 publications

References 34 publications

Distancia al centro de atención en salud y mortalidad durante los primeros años de vida: revisión sistemática y metaanálisis

Distancia al centro de atención en salud y mortalidad durante los primeros años de vida: revisión sistemática y metaanálisis

Distance to Health Centers and Effectiveness of Azithromycin Mass Administration for Children in Niger

Predictors of Health Care Seeking Behavior During Pregnancy, Delivery, and the Postnatal Period in Rural Tanzania

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