Geographic access to care is not a determinant of child mortality in a rural Kenyan setting with high health facility densityReportar como inadecuado

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BMC Public Health

, 10:142

First Online: 17 March 2010Received: 05 November 2009Accepted: 17 March 2010DOI: 10.1186-1471-2458-10-142

Cite this article as: Moïsi, J.C., Gatakaa, H., Noor, A.M. et al. BMC Public Health 2010 10: 142. doi:10.1186-1471-2458-10-142


BackgroundPolicy-makers evaluating country progress towards the Millennium Development Goals also examine trends in health inequities. Distance to health facilities is a known determinant of health care utilization and may drive inequalities in health outcomes; we aimed to investigate its effects on childhood mortality.

MethodsThe Epidemiological and Demographic Surveillance System in Kilifi District, Kenya, collects data on vital events and migrations in a population of 220,000 people. We used Geographic Information Systems to estimate pedestrian and vehicular travel times to hospitals and vaccine clinics and developed proportional-hazards models to evaluate the effects of travel time on mortality hazard in children less than 5 years of age, accounting for sex, ethnic group, maternal education, migrant status, rainfall and calendar time.

ResultsIn 2004-6, under-5 and under-1 mortality ratios were 65 and 46 per 1,000 live-births, respectively. Median pedestrian and vehicular travel times to hospital were 193 min inter-quartile range: 125-267 and 49 min 32-72; analogous values for vaccine clinics were 47 25-73 and 26 min 13-40. Infant and under-5 mortality varied two-fold across geographic locations, ranging from 34.5 to 61.9 per 1000 child-years and 8.8 to 18.1 per 1000, respectively. However, distance to health facilities was not associated with mortality. Hazard Ratios HR were 0.99 95% CI 0.95-1.04 per hour and 1.01 95% CI 0.95-1.08 per half-hour of pedestrian and vehicular travel to hospital, respectively, and 1.00 95% CI 0.99-1.04 and 0.97 95% CI 0.92-1.05 per quarter-hour of pedestrian and vehicular travel to vaccine clinics in children <5 years of age.

ConclusionsSignificant spatial variations in mortality were observed across the area, but were not correlated with distance to health facilities. We conclude that given the present density of health facilities in Kenya, geographic access to curative services does not influence population-level mortality.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2458-10-142 contains supplementary material, which is available to authorized users.

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Autor: Jennifer C Moïsi - Hellen Gatakaa - Abdisalan M Noor - Thomas N Williams - Evasius Bauni - Benjamin Tsofa - Orin S Lev


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