The effect of distance to formal health facility on childhood mortality in rural Tanzania, 2005–2007

Kadobera, Daniel; Sartorius, Benn; Masanja, Honorati; Alexander, Mathew; Waiswa, Peter

doi:10.3402/gha.v5i0.19099

Cited by 94 publications

(93 citation statements)

References 24 publications

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“…A study of Demographic Health Survey (DHS) data from the DRC in 2007 found unexpected geographic patterns in under-5 mortality, and highlights subnational areas where a potential confluence of individual, household and environmental elements affecting child mortality may be spatially clustered [42]. Studies in rural Tanzania and Burkina Faso found that physical access to health facilities was associated with child mortality [43,44]. A study of the spatial distribution of under-5 mortality across and within 20 African countries using data from the late 1970s to the early 1990s ascribed geographic patterns to similar disease environments in eastern Africa and to economic development along the coast of western Africa [12].…”

Section: Introductionmentioning

confidence: 99%

Using geographical analysis to identify child health inequality in sub-Saharan Africa

et al. 2018

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One challenge to achieving Millennium Development Goals was inequitable access to quality health services. In order to achieve the Sustainable Development Goals, interventions need to reach underserved populations. Analyzing health indicators in small geographic units aids the identification of hotspots where coverage lags behind neighboring areas. The purpose of these analyses is to identify areas of low coverage or high need in order to inform effective resource allocation to reduce child health inequity between and within countries. Using data from The Demographic and Health Survey Program surveys conducted in 27 selected African countries between 2010 and 2014, we computed estimates for six child health indicators for subnational regions. We calculated Global Moran’s I statistics and used Local Indicator of Spatial Association analysis to produce a spatial layer showing spatial associations. We created maps to visualize sub-national autocorrelation and spatial clusters. The Global Moran’s I statistic was positive for each indicator (range: 0.41 to 0.68), and statistically significant (p <0.05), suggesting spatial autocorrelation across national borders, and highlighting the need to examine health indicators both across countries and within them. Patterns of substantial differences among contiguous subareas were apparent; the average intra-country difference for each indicator exceeded 20 percentage points. Clusters of cross-border associations were also apparent, facilitating the identification of hotspots and informing the allocation of resources to reduce child health inequity between and within countries. This study exposes differences in health indicators in contiguous geographic areas, indicating that specific regional and subnational, in addition to national, strategies to improve health and reduce health inequalities are warranted.

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Section: Introductionmentioning

confidence: 99%

Using geographical analysis to identify child health inequality in sub-Saharan Africa

et al. 2018

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“…5,6 These barriers are thought to contribute to increased child mortality, for instance long distance from a health facility increased mortality risk by 17% in Tanzania. 7 Malnutrition, previous hospitalizations and HIV are often identified as key risk factors for post-discharge mortality. 4 While these risk factors may assist clinicians in the identification of vulnerable children, many other contextual and social factors may contribute to post-discharge mortality.…”

Section: Introductionmentioning

confidence: 99%

Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study

L¹,

Kumbakumba²,

et al. 2017

Afr H. Sci.

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Background: Out-of-hospital death among children living in resource poor settings occurs frequently. Little is known about the location and circumstances of child death following a hospital discharge. Objectives: This study aimed to understand the context surrounding out-of-hospital deaths and the barriers to accessing timely care for Ugandan children recently discharged from the hospital. Methods: This was a mixed-methods sub-study within a larger cohort study of post-discharge mortality conducted in the Southwestern region of Uganda. Children admitted with an infectious illness were eligible for enrollment in the cohort study, and then followed for six months after discharge. Caregivers of children who died outside of the hospital during the six month post-discharge period were eligible to participate in this sub-study. Qualitative interviews and univariate logistic regression were conducted to determine predictors of out-of-hospital deaths. Results: Of 1,242 children discharged, 61 died during the six month post-discharge period, with most (n=40, 66%) dying outside of a hospital. Incremental increases in maternal education were associated with lower odds of out-of-hospital death compared to hospital death (OR: 0.38, 95% CI: 0.19 -0.81). The qualitative analysis identified health seeking behaviors and common barriers within the post-discharge period which delayed care seeking prior to death. For recently discharged children, caregivers often expressed hesitancy to seek care following a recent episode of hospitalization. Conclusion: Mortality following discharge often occurs outside of a hospital context. In addition to resource limitations, the health knowledge and perceptions of caregivers can be influential to timely access to care. Interventions to decrease child mortality must consider barriers to health seeking among children following hospital discharge. Keywords: Pediatrics, post-discharge mortality, Uganda, qualitative interviews, infectious diseas.

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“…Para los estudios de mortalidad infantil se consideran, como variables para el control de confusión, principalmente condiciones de antecedentes perinatales tipo multiparidad, periodo intergenésico y número de partos previos y, en menor medida, condiciones sociales tipo etnia, ausencia de la madre y su nivel educativo. Por último, en relación con la mortalidad en la niñez se identificó asociación significativa en ocho estudios, con un riesgo entre quienes habitan a mayor distancia que podría ser tan bajo como 1,02 veces el riesgo de quienes habitan a menos de 2 horas de camino en Tanzania [45], y no mayor a 4,43 veces el riesgo de quienes habitan a menos de 5 km en Gambia [15]. Si bien este es el grupo de edad con mayor cantidad de estudios realizados, es también el que muestra resultados más heterogéneos.…”

Section: Revisión Sistemáticaunclassified

“…De forma contraria, las publicaciones basadas en diseños de cohorte o longitudinal, a partir de las cuales se obtuvo una estimación de 1,32 (IC95% 1,04-1,67), presentaron varianza significativa (valor p < 0,01) y de alto impacto en la interpretabilidad de la medida resumen (I 2 = 86%). La heterogeneidad observada entre estos últimos artículos también está relacionada con la diferencia particular en el resultado del trabajo de Zaman [15], la cual es más del doble de las estimaciones de Schoeps [51] y Kadobera [45].…”

Section: Análisis De Sensibilidadunclassified

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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The effect of distance to formal health facility on childhood mortality in rural Tanzania, 2005–2007

Cited by 94 publications

References 24 publications

Using geographical analysis to identify child health inequality in sub-Saharan Africa

Using geographical analysis to identify child health inequality in sub-Saharan Africa

Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study

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

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