Remoteness and maternal and child health service utilization in rural Liberia: A population–based survey

Abstract

BackgroundThis study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa.MethodsCluster–sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS–measured distance from the nearest health facility and the odds of maternal (ANC, facility–based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data.FindingsLiving in the farthest quartile was associated with lower odds of attending 1–or–more ANC checkup (AOR = 0.04, P < 0.001), 4–or–more ANC checkups (AOR = 0.13, P < 0.001), delivering in a facility (AOR = 0.41, P = 0.006), and postnatal care from a health care worker (AOR = 0.44, P = 0.009). Children living in all other quartiles had lower odds of seeking facility–based fever care (AOR for fourth quartile = 0.06, P < 0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR = 0.16, P < 0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR = 0.05, P = 0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers.ConclusionsWithin a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further dissemination of providers and greater use of community health workers should be prioritized.

PRECEDE- PROCEED Model on Determinants of Completeness Immunization Status among Infants in Bangkalan District, Madura

“…It is in line with Kenny et al (2015) that the long distance between dwelling place of a family and healthcare facilities may reduce the seek for and utilization of healthcare facilities moreover if accessing healthcare facility is costly. 6.…”

“…The long distance between dwelling place of a family and healthcare facilities may reduce the seeking for and utilization of healthcare facilities (Kenny et al, 2015).…”

A look back on how far to walk: Systematic review and meta-analysis of physical access to skilled care for childbirth in Sub-Saharan Africa

“…In the remaining 15 studies which did not use self-reported exposures, distance was measured or estimated using geographic data, including one (De Groot et al 1991 [ 26 ]) that interviewed women attending a HF for childbirth about their distance from home village, whilst address and other data for women with non-facility births were calculated using local census data. Among the other 14 studies, Nwakoby 1992 [ 28 ] measured distance directly on a printed map; and Kenny et al 2015 [ 29 ] tracked distance with a handheld positioning device during field workers’ travels to the communities for household interviews. The rest integrated geolocated data of women’s home or communities and a complete listing of HFs of the study area in a GIS.…”

Facility-Based Delivery during the Ebola Virus Disease Epidemic in Rural Liberia: Analysis from a Cross-Sectional, Population-Based Household Survey

“…At the first stage, we sampled villages with probability proportionate to size within each stratum using the standard DHS approach: listing clusters with a running cumulative number of households, determining the sampling interval necessary to take the correct number of clusters, randomly determining a starting value, and then selecting each subsequent cluster that corresponded to the sampling interval [ 42 – 44 ]. At the second stage, 21 households were selected per cluster in compact segments by (1) spinning a laminated paper triangle on the ground in the village’s center, (2) using a random number generator to randomly select an initial house in the direction pointed between the center and margin of the village, and (3) continuing to the next closest dwelling until 21 households were sampled [ 45 , 46 ]. We surveyed all women aged 18 to 49 in each selected household.…”