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Apetoh E, Tilly M, Baxerres C, Le Hesran JY. Home treatment and use of informal market of pharmaceutical drugs for the management of paediatric malaria in Cotonou, Benin. Malar J 2018; 17:354. [PMID: 30305107 PMCID: PMC6180418 DOI: 10.1186/s12936-018-2504-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria is the main cause of hospital admissions in Benin and a leading cause of death in childhood. Beside consultations, various studies have underlined the management of the disease through home treatment. The medicines used can be purchased in informal market of pharmaceutical drugs (IMPD) without prescription or any involvement of healthcare professional. Pharmaceutical drugs are sold by informal private vendors, who operate at any time in the immediate environment of the patients. The present study was conducted in Cotonou to study the health-seeking behaviour of caregivers to treat malaria in children under 12 years old. Factors associated with malaria home treatment and drugs purchase in IMPD were studied. METHODS A cross-sectional study was carried out among 340 children's caregivers who were interviewed about their socio-demographic characteristics and their care-seeking behaviour during the most recent episode of malaria in their children under 12. Medicines used and purchase place were also collected. Multivariate logistic regression model was used to determine factors associated with malaria home treatment and drug purchase in IMPD. RESULTS Beyond all the 340 caregivers, 116 (34%) consulted healthcare professional, 224 (66%) home treat the children, among whom 207 (61%) gave pharmaceutical drugs and 17 (5%) gave traditional remedies to children. Malaria home treatment was associated with family size, health insurance (OR = 0.396, 95% CI 0.169-0.928), and wealth quintiles where home treatment was less used by the richest (OR = 0.199, 95% CI 0.0676-0.522) compared to those in the poorest quintile. The caregivers age group 30-39 years was associated to the use of IMPD (OR = 0.383, 95% CI 0.152-0.964), the most economically wealthy people were less likely to use IMPD (wealth quintile richest: OR = 0.239, 95% CI 0.064-0.887; wealth quintile fourth OR = 0.271, 95% CI 0.100-0.735) compared to those in the poorest quintile. All caregivers who benefited from health insurance did not use IMPD. CONCLUSION This study highlights the link between worse economic conditions and accessibility to medical care as one of the main factors of malaria home treatment and drug purchase in IMPD, even if those two phenomena need to be understood apart.
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Affiliation(s)
- Edwige Apetoh
- Institut de recherche pour le développement, Unité mixte de recherche 216: Mères et enfants face aux infections tropicales, Université Paris-Descartes, 4 Avenue de l'Observatoire, 75006, Paris, France.
- Ecole doctorale Pierre Louis de santé publique, ED 393 Epidémiologie et Sciences de l'Information Biomédicale, Paris, France.
| | - Marina Tilly
- Institut de recherche pour le développement, Unité mixte de recherche 216: Mères et enfants face aux infections tropicales, Université Paris-Descartes, 4 Avenue de l'Observatoire, 75006, Paris, France
| | - Carine Baxerres
- Institut de recherche pour le développement, Unité mixte de recherche 216: Mères et enfants face aux infections tropicales, Université Paris-Descartes, 4 Avenue de l'Observatoire, 75006, Paris, France
- Centre Norbert Elias EHESS-Campus Marseille La Vieille Charité, 2 Rue de la Charité, 13002, Marseille, France
| | - Jean-Yves Le Hesran
- Institut de recherche pour le développement, Unité mixte de recherche 216: Mères et enfants face aux infections tropicales, Université Paris-Descartes, 4 Avenue de l'Observatoire, 75006, Paris, France
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Yourkavitch J, Burgert-Brucker C, Assaf S, Delgado S. Using geographical analysis to identify child health inequality in sub-Saharan Africa. PLoS One 2018; 13:e0201870. [PMID: 30157198 PMCID: PMC6114521 DOI: 10.1371/journal.pone.0201870] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 06/24/2018] [Indexed: 01/24/2023] Open
Abstract
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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Affiliation(s)
| | | | - Shireen Assaf
- The DHS Program, ICF, Rockville, Maryland, United States of America
| | - Stephen Delgado
- ICAP, Mailman School of Public Health, Columbia University, New York, New York, United States of America
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Winchester MS, King B. Decentralization, healthcare access, and inequality in Mpumalanga, South Africa. Health Place 2018; 51:200-207. [DOI: 10.1016/j.healthplace.2018.02.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 02/12/2018] [Accepted: 02/23/2018] [Indexed: 11/16/2022]
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Ippolito MM, Kamavu LK, Kabuya JB, Tente C, Chileshe E, Wapachole M, Thuma PE, Muleba M, Chaponda M, Mulenga M, Moss WJ, For The Southern And Central Africa International Centers Of Excellence For Malaria Research. Risk Factors for Mortality in Children Hospitalized with Severe Malaria in Northern Zambia: A Retrospective Case-Control Study. Am J Trop Med Hyg 2018; 98:1699-1704. [PMID: 29692306 PMCID: PMC6086172 DOI: 10.4269/ajtmh.17-1017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Malaria remains a public health crisis in areas where it has resisted control efforts. In Nchelenge District, a high-transmission area in northern Zambia, malaria accounts for more than one-third of pediatric hospitalizations and nearly one-half of hospital deaths in children. To identify risk factors for death due to malaria, we conducted a retrospective, time-matched case-control study of 126 children hospitalized with malaria who died (cases) and 126 children who survived (controls). There were no differences in age, gender, hemoglobin concentration, or prevalence of severe anemia between cases and controls. Children who died were more likely to come from villages located at greater distances from the hospital than children who survived (median 13.5 versus 3.2 km). Each additional kilometer of distance from the hospital increased the odds of death by 4% (odds ratio 1.04, 95% confidence interval 1.01–1.07, P < 0.01). Extent of anemia and admission during periods when blood was unavailable for transfusion were associated with early death (P ≤ 0.03). Delays in initiation of treatment of severe malaria contribute to the increased odds of death in children referred from more distant health centers, and might be mitigated by transportation improvements, capacity at rural health posts to administer treatment before transfer, hospital triage systems that minimize time to treatment, and reliable blood product stores at referral hospitals.
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Affiliation(s)
- Matthew M Ippolito
- Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Luc K Kamavu
- Office of Hospital Administration, Saint Paul's General Hospital, Nchelenge, Zambia
| | | | - Catherine Tente
- Office of Hospital Administration, Saint Paul's General Hospital, Nchelenge, Zambia
| | - Edward Chileshe
- Office of Health Management Information Systems, Saint Paul's General Hospital, Nchelenge, Zambia
| | | | - Philip E Thuma
- Macha Research Trust, Macha, Zambia.,Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | - William J Moss
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Malaria Research Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Abstract
Background Nigeria is one of the countries endemic for Buruli ulcer (BU) in West Africa but did not have a control programme until recently. As a result, BU patients often access treatment services in neighbouring Benin where dedicated health facilities have been established to provide treatment free of charge for BU patients. This study aimed to describe the epidemiological, clinical, biological and therapeutic characteristics of cases from Nigeria treated in three of the four treatment centers in Benin. Methodology/Principal findings A series of 82 BU cases from Nigeria were treated in three centres in Benin during 2006–2016 and are retrospectively described. The majority of these patients came from Ogun and Lagos States which border Benin. Most of the cases were diagnosed with ulcerative lesions (80.5%) and WHO category III lesions (82.9%); 97.5% were healed after a median hospital stay of 46 days (interquartile range [IQR]: 32–176 days). Conclusions/Significance This report adds to the epidemiological understanding of BU in Nigeria in the hope that the programme will intensify efforts aimed at early case detection and treatment. Buruli ulcer (BU) is a neglected tropical disease that mainly affects the skin. The disease results from infection with Mycobacterium ulcerans, an environmental bacterium. In Benin, the BU treatment centres usually receive patients from Nigeria. In 2014, a study from one of the treatment centres (CDTUB, Pobe) which borders south-western Nigeria reported on a cohort of 127 PCR-confirmed cases between 2005 and 2013. We describe the epidemiological, clinical, biological and therapeutic characteristics of BU cases from Nigeria treated in the three other CDTUBs.
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Geographic Accessibility to Health Services and Neonatal Mortality Among Very-Low Birthweight Infants in South Carolina. Matern Child Health J 2017; 20:2382-2391. [PMID: 27406152 DOI: 10.1007/s10995-016-2065-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Introduction Mortality for infants born with very-low birthweight (VLBW, 500-1499 grams) is markedly higher than for babies born with normal birthweight (2500-4000 grams). Although these high-risk infants show better outcomes in advanced care settings, only 80 % of VLBW infants born in South Carolina (SC) are delivered in hospitals with a level-III neonatal intensive care unit (NICU). The purpose of this research project was to assess geographic access to delivery hospitals and risk of neonatal death among singleton VLBW infants born in SC. Methods The linked birth and death records of a cross-sectional, population-based study of singleton VLBW infants born in SC between 2010 and 2012 were used (n = 2030). We assessed the impact of travel time from maternal residence to delivery hospital. Logistic regression modeling was performed with adjustments for maternal, newborn, and hospital characteristics. Results The neonatal mortality rate among singleton VLBW infants was 11.03 deaths per 100 live births in 2010-2012. We did not find a significant association between travel time to delivery hospital and neonatal mortality after adjusting for confounders. However, we found that a 1-week increase in gestational age (odds ratio (OR): 0.61) and non-Hispanic black mothers (versus non-Hispanic white mothers) (OR: 0.68) were associated with lower odds of neonatal death, whereas non-NICU admission at birth (OR: 5.90) was associated with increased odds of death. The results of the sensitivity analyses including both singleton and multiple births did not yield significant results for travel time and neonatal mortality in VLBW infants. Discussion Although we found no significant association between travel time and neonatal mortality in singleton VLBW births in SC, we identified significant factors consistent with those found in previous studies that may affect neonatal mortality.
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Differences in Spontaneous Intracerebral Hemorrhage Cases between Urban and Rural Regions of Taiwan: Big Data Analytics of Government Open Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14121548. [PMID: 29232864 PMCID: PMC5750966 DOI: 10.3390/ijerph14121548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 12/01/2017] [Accepted: 12/06/2017] [Indexed: 11/21/2022]
Abstract
This study evaluated the differences in spontaneous intracerebral hemorrhage (sICH) between rural and urban areas of Taiwan with big data analysis. We used big data analytics and visualization tools to examine government open data, which included the residents’ health medical administrative data, economic status, educational status, and relevant information. The study subjects included sICH patients of Taipei region (29,741 cases) and Eastern Taiwan (4565 cases). The incidence of sICH per 100,000 population per year in Eastern Taiwan (71.3 cases) was significantly higher than that of the Taipei region (42.3 cases). The mean coverage area per hospital in Eastern Taiwan (452.4 km2) was significantly larger than the Taipei region (24 km2). The residents educational level in the Taipei region was significantly higher than that in Eastern Taiwan. The mean hospital length of stay in the Taipei region (17.9 days) was significantly greater than that in Eastern Taiwan (16.3 days) (p < 0.001). There were no significant differences in other medical profiles between two areas. Distance and educational barriers were two possible reasons for the higher incidence of sICH in the rural area of Eastern Taiwan. Further studies are necessary in order to understand these phenomena in greater depth.
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Boateng S, Amoako P, Poku AA, Baabereyir A, Gyasi RM. Migrant female head porters' enrolment in and utilisation and renewal of the National Health Insurance Scheme in Kumasi, Ghana. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2017; 25:625-634. [PMID: 29177126 PMCID: PMC5681982 DOI: 10.1007/s10389-017-0832-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/20/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE As a social protection policy, Ghana's National Health Insurance Scheme (NHIS) aims to improve access to healthcare, especially for the vulnerable. Migrant female head porters (kayayoo), who are part of the informal economic workforce, are underscored as an ethnic minority and vulnerable group in Ghana. This study aimed to analyse the factors associated with enrolment in and renewal and utilisation of the NHIS among migrant female head porters in the Kumasi Metropolis. METHOD We purposively sampled 392 migrant female head porters in the Kejetia, Asafo and Bantama markets. We used a binary logit regression model to estimate associations among baseline characteristics, convenience and benefit factors and enrolment in and renewal and utilisation of the NHIS. RESULT Age and income significantly increased the probability of NHIS enrolment, renewal and utilisation. Long waiting times at NHIS offices significantly reduced the likelihood of renewal, while provision of drugs highly significantly increased the tendency for migrant female head porters to enrol in, renew and use the NHIS. Consulting and surgery also significantly increased renewal and utilisation of the NHIS. CONCLUSION Political commitment is imperative for effective implementation of the decentralisation policy of the NHIS through the National Health Insurance Authority in Kumasi. We argue that retail offices should be well equipped with logistic facilities to ensure convenience in NHIS initial enrolment and renewal processes by citizenry, and by vulnerable groups in particular.
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Affiliation(s)
- Simon Boateng
- Social Sciences Department, St. Monica’s College of Education, Mampong, Ghana
| | - Prince Amoako
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adjoa Afriyie Poku
- Department of Geography Education, University of Education, Winneba, Ghana
| | - Anthony Baabereyir
- Department of Geography Education, University of Education, Winneba, Ghana
| | - Razak Mohammed Gyasi
- Department of Sociology and Social Policy, Faculty of Social Sciences, Lingnan University, Teun Mun, Hong Kong
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Khagayi S, Amek N, Bigogo G, Odhiambo F, Vounatsou P. Bayesian spatio-temporal modeling of mortality in relation to malaria incidence in Western Kenya. PLoS One 2017; 12:e0180516. [PMID: 28704417 PMCID: PMC5509217 DOI: 10.1371/journal.pone.0180516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 06/17/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The effect of malaria exposure on mortality using health facility incidence data as a measure of transmission has not been well investigated. Health and demographic surveillance systems (HDSS) routinely capture data on mortality, interventions and other household related indicators, offering a unique platform for estimating and monitoring the incidence-mortality relationship in space and time. METHODS Mortality data from the HDSS located in Western Kenya collected from 2007 to 2012 and linked to health facility incidence data were analysed using Bayesian spatio-temporal survival models to investigate the relation between mortality (all-cause/malaria-specific) and malaria incidence across all age groups. The analysis adjusted for insecticide-treated net (ITN) ownership, socio-economic status (SES), distance to health facilities and altitude. The estimates obtained were used to quantify excess mortality due to malaria exposure. RESULTS Our models identified a strong positive relationship between slide positivity rate (SPR) and all-cause mortality in young children 1-4 years (HR = 4.29; 95% CI: 2.78-13.29) and all ages combined (HR = 1.55; 1.04-2.80). SPR had a strong positive association with malaria-specific mortality in young children (HR = 9.48; 5.11-37.94), however, in older children (5-14 years), it was associated with a reduction in malaria specific mortality (HR = 0.02; 0.003-0.33). CONCLUSION SPR as a measure of transmission captures well the association between malaria transmission intensity and all-cause/malaria mortality. This offers a quick and efficient way to monitor malaria burden. Excess mortality estimates indicate that small changes in malaria incidence substantially reduce overall and malaria specific mortality.
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Affiliation(s)
- Sammy Khagayi
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nyaguara Amek
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Godfrey Bigogo
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Frank Odhiambo
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Penelope Vounatsou
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Nielsen BU, Byberg S, Aaby P, Rodrigues A, Benn CS, Fisker AB. Seasonal variation in child mortality in rural Guinea-Bissau. Trop Med Int Health 2017; 22:846-856. [PMID: 28464403 PMCID: PMC5811910 DOI: 10.1111/tmi.12889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives In many African countries, child mortality is higher in the rainy season than in the dry season. We investigated the effect of season on child mortality by time periods, sex and age in rural Guinea‐Bissau. Methods Bandim health project follows children under‐five in a health and demographic surveillance system in rural Guinea‐Bissau. We compared the mortality in the rainy season (June to November) between 1990 and 2013 with the mortality in the dry season (December to May) in Cox proportional hazards models providing rainy vs. dry season mortality rate ratios (r/d‐mrr). Seasonal effects were estimated in strata defined by time periods with different frequency of vaccination campaigns, sex and age (<1 month, 1–11 months, 12–59 months). Verbal autopsies were interpreted using InterVa‐4 software. Results From 1990 to 2013, overall mortality was declined by almost two‐thirds among 81 292 children (10 588 deaths). Mortality was 51% (95% ci: 45–58%) higher in the rainy season than in the dry season throughout the study period. The seasonal difference increased significantly with age, the r/d‐mrr being 0.94 (0.86–1.03) among neonates, 1.57 (1.46–1.69) in post‐neonatal infants and 1.83 (1.72–1.95) in under‐five children (P for same effect <0.001). According to the InterVa, malaria deaths were the main reason for the seasonal mortality difference, causing 50% of all deaths in the rainy season, but only if the InterVa included season of death, making the argument self‐confirmatory. Conclusion The mortality declined throughout the study, yet rainy season continued to be associated with 51% higher overall mortality.
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Affiliation(s)
- Bibi Uhre Nielsen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | - Stine Byberg
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Peter Aaby
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark
| | | | - Christine Stabell Benn
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
| | - Ane Baerent Fisker
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau.,Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark.,OPEN, Institute of Clinical Research, University of Southern Denmark/Odense University Hospital, Odense, Denmark
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Biswas RK, Kabir E. Influence of distance between residence and health facilities on non-communicable diseases: An assessment over hypertension and diabetes in Bangladesh. PLoS One 2017; 12:e0177027. [PMID: 28545074 PMCID: PMC5436657 DOI: 10.1371/journal.pone.0177027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/20/2017] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE This paper reflected on the prevalence of hypertension and diabetes in Bangladesh, which is spreading rapidly in low-income countries. The rationale of constructing more health centers for addressing NCDs was assessed in this paper by determining the relationship between prevalence of NCDs, particularly hypertension and diabetes, and distance to health facilities. METHODS From BDHS (Bangladesh Health and Demographic Survey) 2011 data set, 7544 samples were analyzed to demonstrate association between Non-communicable diseases (NCD) and distance from respondents' home to health facilities like hospitals, community clinics, pharmacies or doctors' chambers, and community facilities like market, post office or cinema hall. Bivariate analysis was conducted between accessibility to health facilities and prevalence of the diseases. The causal relationship between the spatial effects and the prevalence of the diseases were analyzed by applying Generalized Linear Mixed Model (GLMM) was fitted. RESULTS Fitting linear mixed effect models, we found that hypertension and diabetes react differently with various spatial effects. Distance from home to hospital had significant effect (P < 0.001) on hypertension showing people living further from the facilities or town centers seemed to be less hypertensive, whereas diabetes showed no such affiliation. CONCLUSION Higher prevalence of diabetes (40.9%) over hypertension (26.5%) in people aging 35 or higher, have appeared to have caused the difference, which concluded that each non-communicable disease should be dealt to its own merit for policy making instead considering as a group of diseases.
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Affiliation(s)
- Raaj Kishore Biswas
- School of Agricultural, Computational and Environmental Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Enamul Kabir
- School of Agricultural, Computational and Environmental Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
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Mohammadi Y, Parsaeian M, Mehdipour P, Khosravi A, Larijani B, Sheidaei A, Mansouri A, Kasaeian A, Yazdani K, Moradi-Lakeh M, Kazemi E, Aghamohamadi S, Rezaei N, Chegini M, Haghshenas R, Jamshidi H, Delavari F, Asadi-Lari M, Farzadfar F. Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015. LANCET GLOBAL HEALTH 2017; 5:e537-e544. [PMID: 28363513 DOI: 10.1016/s2214-109x(17)30105-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 02/02/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Child mortality as one of the key Millennium Development Goals (MDG 4-to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2-to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all countries by 2030), and is a key indicator of the health system in every country. In this study, we aimed to estimate the level and trend of child mortality from 1990 to 2015 in Iran, to assess the progress of the country and its provinces toward these goals. METHODS We used three different data sources: three censuses, a Demographic and Health Survey (DHS), and 5-year data from the death registration system. We used the summary birth history data from four data sources (the three censuses and DHS) and used maternal age cohort and maternal age period methods to estimate the trends in child mortality rates, combining the estimates of these two indirect methods using Loess regression. We also used the complete birth history method to estimate child mortality rate directly from DHS data. Finally, to synthesise different trends into a single trend and calculate uncertainty intervals (UI), we used Gaussian process regression. FINDINGS Under-5 mortality rates (deaths per 1000 livebirths) at the national level in Iran in 1990, 2000, 2010, and 2015 were 63·6 (95% UI 63·1-64·0), 38·8 (38·5-39·2), 24·9 (24·3-25·4), and 19·4 (18·6-20·2), respectively. Between 1990 and 2015, the median annual reduction and total overall reduction in these rates were 4·9% and 70%, respectively. At the provincial level, the difference between the highest and lowest child mortality rates in 1990, 2000, and 2015 were 65·6, 40·4, and 38·1 per 1000 livebirths, respectively. Based on the MDG 4 goal, five provinces had not decreased child mortality by two-thirds by 2015. Furthermore, six provinces had not reached SDG 3 (target 2). INTERPRETATION Iran and most of its provinces achieved MDG 4 and SDG 3 (target 2) goals by 2015. However, at the subnational level in some provinces, there is substantial inequity. Local policy makers should use effective strategies to accelerate the reduction of child mortality for these provinces by 2030. Possible recommendations for such strategies include enhancing the level of education and health literacy among women, tackling sex discrimination, and improving incomes for families. FUNDING Iran Ministry of Health and Education.
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Affiliation(s)
- Younes Mohammadi
- Modelling of Noncommunicable Diseases Research Center, Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mahboubeh Parsaeian
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parinaz Mehdipour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ardeshir Khosravi
- Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sheidaei
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Anita Mansouri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Kasaeian
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kamran Yazdani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maziar Moradi-Lakeh
- Preventive Medicine and Public Health Research Center, Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elaheh Kazemi
- Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Saeide Aghamohamadi
- Deputy for Public Health, Ministry of Health and Medical Education, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Chegini
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rosa Haghshenas
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamshidi
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnaz Delavari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, and Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Anthopolos R, Simmons R, O'Meara WP. A retrospective cohort study to quantify the contribution of health systems to child survival in Kenya: 1996-2014. Sci Rep 2017; 7:44309. [PMID: 28290505 PMCID: PMC5349518 DOI: 10.1038/srep44309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/06/2017] [Indexed: 12/02/2022] Open
Abstract
Globally, the majority of childhood deaths in the post-neonatal period are caused by infections that can be effectively treated or prevented with inexpensive interventions delivered through even very basic health facilities. To understand the role of inadequate health systems on childhood mortality in Kenya, we assemble a large, retrospective cohort of children (born 1996–2013) and describe the health systems context of each child using health facility survey data representative of the province at the time of a child’s birth. We examine the relationship between survival beyond 59 months of age and geographic distribution of health facilities, quality of services, and cost of services. We find significant geographic heterogeneity in survival that can be partially explained by differences in distribution of health facilities and user fees. Higher per capita density of health facilities resulted in a 25% reduction in the risk of death (HRR = 0.73, 95% CI:0.58 to 0.91) and accounted for 30% of the between-province heterogeneity in survival. User fees for sick-child visits increased risk by 30% (HRR = 1.30, 95% CI:1.11 to 1.53). These results implicate health systems constraints in child mortality, quantify the contribution of specific domains of health services, and suggest priority areas for improvement to accelerate reductions in child mortality.
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Zombré D, De Allegri M, Ridde V. Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso: A controlled interrupted time-series analysis. Soc Sci Med 2017; 179:27-35. [PMID: 28242542 DOI: 10.1016/j.socscimed.2017.02.027] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 02/13/2017] [Accepted: 02/16/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about the long-term effects of user fee exemption policies on health care use in developing countries. We examined the association between user fee exemption and health care use among children under five in Burkina Faso. We also examined how factors related to characteristics of health facilities and their environment moderate this association. METHOD We used a multilevel controlled interrupted time-series design to examine the strength of effect and long term effects of user fee exemption policy on the rate of health service utilization in children under five between January 2004 and December 2014. RESULTS The initiation of the intervention more than doubled the utilization rate with an immediate 132.596% increase in intervention facilities (IRR: 2.326; 95% CI: 1.980 to 2.672). The effect of the intervention was 32.766% higher in facilities with higher workforce density (IRR: 1.328; 95% CI (1.209-1.446)) and during the rainy season (IRR:1.2001; 95% CI: 1.0953-1.3149), but not significant in facilities with higher dispersed populations (IRR: 1.075; 95% CI: (0.942-1.207)). Although the intervention effect was substantially significant immediately following its inception, the pace of growth, while positive over a first phase, decelerated to stabilize itself three years and 7 months later before starting to decrease slowly towards the end of the study period. CONCLUSION This study provides additional evidence to support user fee exemption policies complemented by improvements in health care quality. Future work should include an assessment of the impact of user fee exemption on infant morbidity and mortality and better discuss factors that could explain the slowdown in this upward trend of utilization rates three and a half years after the intervention onset.
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Affiliation(s)
- David Zombré
- University of Montreal Public Health Research Institute - IRSPUM, Canada; School of Public Health, Montreal, Québec, Canada.
| | - Manuela De Allegri
- Institute of Public Health, Medical Faculty, Heidelberg University, Germany
| | - Valéry Ridde
- University of Montreal Public Health Research Institute - IRSPUM, Canada; School of Public Health, Montreal, Québec, Canada
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Dos Anjos Luis A, Cabral P. Geographic accessibility to primary healthcare centers in Mozambique. Int J Equity Health 2016; 15:173. [PMID: 27756374 PMCID: PMC5070361 DOI: 10.1186/s12939-016-0455-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 09/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to healthcare services has an essential role in promoting health equity and quality of life. Knowing where the places are and how much of the population is covered by the existing healthcare network is important information that can be extracted from Geographical Information Systems (GIS) and used in effective healthcare planning. The aim of this study is to measure the geographic accessibility of population to existing Healthcare Centers (HC), and to estimate the number of persons served by the health network of Mozambique. METHODS Health facilities' locations together with population, elevation, and ancillary data were used to model accessibility to HC using GIS. Two travel time scenarios used by population to attend HC were considered: (1) Driving and; and (2) Walking. Estimates of the number of villages and people located in the region served, i.e. within 60 min from an HC, and underserved area, i.e. outside 60 min from an HC, are provided at national and province level. RESULTS The findings from this study highlight accessibility problems, especially in the walking scenario, in which 90.2 % of Mozambique was considered an underserved area. In this scenario, Maputo City (69.8 %) is the province with the greatest coverage of HC. On the other hand, Tete (93.4 %), Cabo Delgado (93 %) and Gaza (92.8 %) are the provinces with the most underserved areas. The driving scenario was less problematic, with about 66.9 % of Mozambique being considered a served area. We also found considerable regional disparities at the province level for this scenario, ranging from 100 % coverage in Maputo City to 48.3 % in Cabo Delgado. In terms of population coverage we found that the problem of accessibility is more acute in the walking scenario, in which about 67.3 % of the Mozambican population is located in underserved areas. For the driving scenario, only 6 % of population is located in underserved areas. CONCLUSIONS This study highlights critical areas in Mozambique in which HC are lacking when assessed by walking and driving travel time distance. The majority of Mozambicans are located in underserved areas in the walking scenario. The mapped outputs may have policy implications and can be used for future decision making processes and analysis. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | - Pedro Cabral
- NOVA IMS, Universidade Nova de Lisboa, 1070-312, Lisboa, Portugal
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Panciera R, Khan A, Rizvi SJR, Ahmed S, Ahmed T, Islam R, Adams AM. The influence of travel time on emergency obstetric care seeking behavior in the urban poor of Bangladesh: a GIS study. BMC Pregnancy Childbirth 2016; 16:240. [PMID: 27549156 PMCID: PMC4994156 DOI: 10.1186/s12884-016-1032-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/15/2016] [Indexed: 11/25/2022] Open
Abstract
Background Availability of Emergency Obstetric Care (EmOC) is crucial to avert maternal death due to life-threatening complications potentially arising during delivery. Research on the determinants of utilization of EmOC has neglected urban settings, where traffic congestion can pose a significant barrier to the access of EmOC facilities, particularly for the urban poor due to costly and limited transportation options. This study investigates the impact of travel time to EmOC facilities on the utilization of facility-based delivery services among mothers living in urban poor settlements in Sylhet, Bangladesh. Methods A cross-sectional EmOC health-seeking behavior survey from 39 poor urban clusters was geo-spatially linked to a comprehensive geo-referenced dataset of EmOC facility locations. Geo-spatial techniques and logistic regression were then applied to quantify the impact of travel time on place of delivery (EmOC facility or home), while controlling for confounding socio-cultural and economic factors. Results Increasing travel time to the nearest EmOC facility is found to act as a strong deterrent to seeking care for the urban poor in Sylhet. Logistic regression results indicate that a 5-min increase in travel time to the nearest EmOC facility is associated with a 30 % decrease (0.655 odds ratio, 95 % CI: 0.529–0.811) in the likelihood of delivery at an EmOC facility rather than at home. Moreover, the impact of travel time varies substantially between public, NGO and private facilities. A 5-min increase in travel time from a private EmOC facility is associated with a 32.9 % decrease in the likelihood of delivering at a private facility, while for public and Non-Government Organizations (NGO) EmOC facilities, the impact is lower (28.2 and 28.6 % decrease respectively). Other strong determinants of delivery at an EmOC facility are the use of antenatal care and mother’s formal education, while Muslim mothers are found to be more likely to deliver at home. Conclusions Geospatial evidence points to the need to strengthen referral and emergency transport systems in order to reduce urban travel time, and establish or relocate EmOC facilities closer to where the poor reside. However, female education and antenatal care coverage remain the most important determinants of facility delivery.
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Affiliation(s)
- Rocco Panciera
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Akib Khan
- James P. Grant School of Public Health, BRAC University, 5th Floor, (Level-6), icddr,b Building, 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Syed Jafar Raza Rizvi
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shakil Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tanvir Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh.,Institute of Development Studies (IDS), University of Sussex, Library Road, University of Sussex, Brighton, East Sussex, BN1 9RE, UK
| | - Rubana Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Alayne M Adams
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212, Bangladesh
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Vallières F, Cassidy EL, McAuliffe E, Gilmore B, Bangura AS, Musa J. Can Sierra Leone maintain the equitable delivery of their Free Health Care Initiative? The case for more contextualised interventions: results of a cross-sectional survey. BMC Health Serv Res 2016; 16:258. [PMID: 27412299 PMCID: PMC4942899 DOI: 10.1186/s12913-016-1496-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 06/28/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In 2010, the Ministry of Health and Sanitation in Sierra Leone launched their Free Health Care Initiative (FHCI) for pregnant and lactating mothers and children under-5. Despite an increase in the update of services, the inequitable distribution of health services and health facilities remain important factors underlying the poor performance of health systems to deliver effective services. This study identifies current gaps in service delivery across two rural locations served by the same District Health Management Team (DHMT). METHODS We employed a cross-sectional household survey using a two-stage probability sampling method to obtain a sample of the population across two rural locations in Bonthe District: the riverine and the mainland. Overall, a total of 393 households across 121 villages were surveyed in the riverine and 397 households across 130 villages were sampled on the mainland. Maternal health, child health and sanitation indicators in Bonthe District were compared using Pearson Chi-Squared test with Yates' Continuity Correction across the two areas. RESULTS Women across the two regions self-reported significantly different uptake of family planning services. Children on the mainland had significantly greater rates of health facility based deliveries; being born in the presence of a skilled birth attendant; completed immunisation schedules; and higher rates of being brought to the health centre within 24 h of developing a fever or a suspected acute respiratory infection. Households on the mainland also reported significantly greater use of treated water and unrestricted access to a latrine. CONCLUSIONS If the government of Sierra Leone is going to deliver on their promise to free health care for pregnant women and their children, and do so in a way that reduces inequalities, greater attention must be paid to the existing service delivery gaps within each District. This is particularly relevant to health policy post-Ebola, as it highlights the need for more contextualised service delivery to ensure equitable access for women and children.
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Affiliation(s)
- Frédérique Vallières
- />Centre for Global Health, Trinity College Dublin, University of Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
- />School of Psychology, Trinity College Dublin, University of Dublin, 2 College Green, Dublin 2, Ireland
| | - Emma Louise Cassidy
- />Centre for Global Health, Trinity College Dublin, University of Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Eilish McAuliffe
- />School of Nursing, Midwifery and Health Systems, College of Health Sciences, University College Dublin, Belfield, Dublin 4, Ireland
| | - Brynne Gilmore
- />Centre for Global Health, Trinity College Dublin, University of Dublin, 7-9 Leinster Street South, Dublin 2, Ireland
| | - Allieu S. Bangura
- />World Vision Sierra Leone, 35 Wilkinson Road, Freetown, Sierra Leone
| | - Joseph Musa
- />World Vision Sierra Leone, 35 Wilkinson Road, Freetown, Sierra Leone
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Rees CP, Hawkesworth S, Moore SE, Dondeh BL, Unger SA. Factors Affecting Access to Healthcare: An Observational Study of Children under 5 Years of Age Presenting to a Rural Gambian Primary Healthcare Centre. PLoS One 2016; 11:e0157790. [PMID: 27336164 PMCID: PMC4919103 DOI: 10.1371/journal.pone.0157790] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 05/08/2016] [Indexed: 11/23/2022] Open
Abstract
Main Objective Prompt access to primary healthcare before onset of severe illness is vital to improve morbidity and mortality rates. The Gambia has high rates of child mortality and research is needed to investigate contributing factors further. This study aimed to identify factors affecting access to primary healthcare for children <5 years (y) in rural Gambia focusing on delayed presentation and severe illness at presentation as indicators in a setting where primary healthcare is delivered free of charge. Methods Data were extracted from an electronic medical records system at a rural primary healthcare clinic in The Gambia for children (0–5y) between 2009 and 2012. First clinic attendances with malaria, lower respiratory tract infections (LRTI) and diarrhoeal disease, the main contributors to mortality in this setting, were identified and categorized as delayed/non-delayed and severe/non-severe representing our two main outcome measures. Potential explanatory variables, identified through a comprehensive literature review were obtained from an ongoing demographic surveillance system for this population. Variables associated with either delayed/non-delayed and/or with severe/non-severe presentations identified by univariate analysis (p<0.1) were assessed in multivariate models using logistic regression (p<0.05). Results Out of 6554 clinic attendances, 571 relevant attendances were identified. Delayed presentation was common (45% of all presentations) and there was a significantly reduced risk associated with being from villages with free regular access to transport (OR 0.502, 95%CI[0.310, 0.814], p = 0.005). Children from villages with free regular transport were also less likely to present with severe illness (OR 0.557, 95%CI[0.325, 0.954], p = 0.033). Conclusions Transport availability rather than distance to health clinic is an important barrier to accessing healthcare for children in The Gambia, and public health interventions should aim to reduce this barrier.
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Affiliation(s)
- Claire P. Rees
- Centre for Primary Care & Public Health, Barts & The London School of Medicine & Dentistry, London, United Kingdom
| | - Sophie Hawkesworth
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC International Nutrition Group, at MRC Keneba, MRC Unit The Gambia, Banjul, The Gambia
| | - Sophie E. Moore
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC International Nutrition Group, at MRC Keneba, MRC Unit The Gambia, Banjul, The Gambia
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom
| | - Bai L. Dondeh
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC International Nutrition Group, at MRC Keneba, MRC Unit The Gambia, Banjul, The Gambia
| | - Stefan A. Unger
- MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC International Nutrition Group, at MRC Keneba, MRC Unit The Gambia, Banjul, The Gambia
- University of Edinburgh, Department of Child Life and Health, Edinburgh, United Kingdom
- * E-mail:
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Becher H, Müller O, Dambach P, Gabrysch S, Niamba L, Sankoh O, Simboro S, Schoeps A, Stieglbauer G, Yé Y, Sié A. Decreasing child mortality, spatial clustering and decreasing disparity in North-Western Burkina Faso. Trop Med Int Health 2016; 21:546-55. [PMID: 26821122 DOI: 10.1111/tmi.12673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Within relatively small areas, there exist high spatial variations of mortality between villages. In rural Burkina Faso, with data from 1993 to 1998, clusters of particularly high child mortality were identified in the population of the Nouna Health and Demographic Surveillance System (HDSS), a member of the INDEPTH Network. In this paper, we report child mortality with respect to temporal trends, spatial clustering and disparity in this HDSS from 1993 to 2012. Poisson regression was used to describe village-specific child mortality rates and time trends in mortality. The spatial scan statistic was used to identify villages or village clusters with higher child mortality. Clustering of mortality in the area is still present, but not as strong as before. The disparity of child mortality between villages has decreased. The decrease occurred in the context of an overall halving of child mortality in the rural area of Nouna HDSS between 1993 and 2012. Extrapolated to the Millennium Development Goals target period 1990-2015, this yields an estimated reduction of 54%, which is not too far off the aim of a two-thirds reduction.
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Affiliation(s)
- Heiko Becher
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Olaf Müller
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Dambach
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Sabine Gabrysch
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | - Louis Niamba
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Osman Sankoh
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany.,INDEPTH Network, Accra, Ghana.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.,Faculty of Public Health, Hanoi Medical School, Hanoi, Vietnam
| | - Seraphin Simboro
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
| | - Anja Schoeps
- Institute of Public Health, University Hospital Heidelberg, Heidelberg, Germany
| | | | | | - Ali Sié
- Centre de Recherche en Santé de Nouna (CRSN), Nouna, Burkina Faso
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People living with HIV travel farther to access healthcare: a population-based geographic analysis from rural Uganda. J Int AIDS Soc 2016; 19:20171. [PMID: 26869359 PMCID: PMC4751409 DOI: 10.7448/ias.19.1.20171] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 12/09/2015] [Accepted: 01/07/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction The availability of specialized HIV services is limited in rural areas of sub-Saharan Africa where the need is the greatest. Where HIV services are available, people living with HIV (PLHIV) must overcome large geographic, economic and social barriers to access healthcare. The objective of this study was to understand the unique barriers PLHIV face when accessing healthcare compared with those not living with HIV in a rural area of sub-Saharan Africa with limited availability of healthcare infrastructure. Methods We conducted a population-based cross-sectional study of 447 heads of household on Bugala Island, Uganda. Multiple linear regression models were used to compare travel time, cost and distance to access healthcare, and log binomial models were used to test for associations between HIV status and access to nearby health services. Results PLHIV travelled an additional 1.9 km (95% CI (0.6, 3.2 km), p=0.004) to access healthcare compared with those not living with HIV, and they were 56% less likely to access healthcare at the nearest health facility to their residence, so long as that facility lacked antiretroviral therapy (ART) services (aRR=0.44, 95% CI (0.24 to 0.83), p=0.011). We found no evidence that PLHIV travelled further for care if the nearest facility supplies ART services (aRR=0.95, 95% CI (0.86 to 1.05), p=0.328). Among those who reported uptake of care at one of two facilities on the island that provides ART (81% of PLHIV and 68% of HIV-negative individuals), PLHIV tended to seek care at a higher tiered facility that provides ART, even when this facility was not their closest facility (30% of PLHIV travelled further than the closest ART facility compared with 16% of HIV-negative individuals), and travelled an additional 2.2 km (p=0.001) to access that facility, relative to HIV-negative individuals (aRR=1.91, 95% CI (1.00 to 3.65), p=0.05). Among PLHIV, residential distance was associated with access to facilities providing ART (RR=0.78, 95% CI (0.61 to 0.99), p=0.044, comparing residential distances of 3–5 km to 0–2 km; RR=0.71, 95% CI (0.58 to 0.87), p=0.001, comparing residential distances of 6–10 km to 0–2 km). Conclusions PLHIV travel longer distances for care, a phenomenon that may be driven by both the limited availability of specialized HIV services and preference for higher tiered facilities.
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Kanté AM, Chung CE, Larsen AM, Exavery A, Tani K, Phillips JF. Factors associated with compliance with the recommended frequency of postnatal care services in three rural districts of Tanzania. BMC Pregnancy Childbirth 2015; 15:341. [PMID: 26689723 PMCID: PMC4687308 DOI: 10.1186/s12884-015-0769-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 12/02/2015] [Indexed: 11/16/2022] Open
Abstract
Background High neonatal mortality persists in Tanzania. Rates of decline are slow, in part because postnatal care (PNC) services for addressing this problem remain severely underutilized. This study assesses factors associated with utilization of PNC among mothers in rural Tanzania. Methods This study analyzed household survey data collected in 2011 to understand health service utilization patterns among women of reproductive age and children less than 5 years of age in the Rufiji, Kilombero, and Ulanga districts of Tanzania. A total of 889 mothers were eligible for the current analysis. Multinomial logistic regression was used to determine factors associated with the likelihood of mothers seeking the WHO recommended PNC visits. Results The percent of newborns and their mothers with full PNC was low (10.4 %). Factors explaining PNC completion were district of residence, ethnic group, pregnancy wantedness, ANC attendance, place of delivery, and any incidence of newborn. Mothers of unwanted pregnancies were less likely to attend PNC services compared to mothers of wanted pregnancies [for at least two PNC: aRRR = 0.57, 95 % CI 0.35–0.94]. Sick newborns were more likely to receive PNC than newborns who were not sick during the first month after childbirth [for at least two PNC, aRRR = 3.52, 95 % CI 2.12–5.86]. Mothers who attended ANC services more frequently were more likely to receive PNC services compared to those who had attended fewer than 2 ANC services [for 1 PNC, aRRR = 1.89, 95 % CI 1.23–2.90]. Mothers who delivered at a health facility were less likely to attend PNC services compared to mothers who delivered outside a facility [for at least 2 PNC: aRRR = 0.42, 95 % CI 0.26–0.76]. Model with interactions between ANC attendance and place of delivery shown that only ANC attendance had a positive and statistically significant effect on PNC visit. Conclusion To achieve the WHO recommended number of PNC in rural Tanzania, our findings suggest the need to provide PNC through the community-based primary health care. Efforts to improve coverage of PNC should include expanding health education and counseling during childbirth and neonatal period to more effectively advocate PNC for newborns perceived to be healthy.
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Affiliation(s)
- Almamy M Kanté
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA. .,Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania.
| | - Christine E Chung
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Anna M Larsen
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Amon Exavery
- Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania.
| | - Kassimu Tani
- Ifakara Health Institute, PO Box 78373, Mikocheni, Dar es Salaam, Tanzania.
| | - James F Phillips
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
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Kenny A, Basu G, Ballard M, Griffiths T, Kentoffio K, Niyonzima JB, Sechler GA, Selinsky S, Panjabi RR, Siedner MJ, Kraemer JD. Remoteness and maternal and child health service utilization in rural Liberia: A population-based survey. J Glob Health 2015; 5:020401. [PMID: 26207180 PMCID: PMC4512264 DOI: 10.7189/jogh.05.020401] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This 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. METHODS Cluster-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. FINDINGS Living 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. CONCLUSIONS Within 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.
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Affiliation(s)
| | - Gaurab Basu
- Last Mile Health, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA ; Cambridge Health Alliance, Cambridge, MA, USA
| | | | | | | | | | - G Andrew Sechler
- Last Mile Health, Boston, MA, USA ; Harvard Medical School, Boston, MA, USA ; Brigham and Women's Hospital, Boston, MA, USA
| | | | - Rajesh R Panjabi
- Last Mile Health, Boston, MA, USA ; Brigham and Women's Hospital, Boston, MA, USA
| | | | - John D Kraemer
- Georgetown University Medical Center, Washington, DC, USA
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Guenther T, Sadruddin S, Chimuna T, Sichamba B, Yeboah-Antwi K, Diakite B, Modibo B, Swedberg E, R. Marsh D. Beyond distance: an approach to measure effective access to case management for sick children in Africa. Am J Trop Med Hyg 2015; 87:77-84. [PMID: 23136281 PMCID: PMC3748526 DOI: 10.4269/ajtmh.2012.11-0747] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Health planners commonly use geographic proximity to define access to health services. However, effective access to case management requires reliable access to a trained, supplied provider. We defined effective access as the proportion of the study population with geographic access, corrected for other barriers, staffing patterns, and medicine availability. We measured effective access through a cross-sectional survey of 32 health facilities in Malawi, Mali, and Zambia and modeled the potential contribution of community case management (CCM). The population living within Ministry of Health (MOH)–defined geographic access was 43% overall (range = 18–52%), but effective access was only 14% overall (range = 9–17%). Implementing CCM as per MOH plans increased geographic access to 63–90% and effective access to 30–57%. Access to case management is much worse than typically estimated by distance. The CCM increases access dramatically, again if providers are available and supplied, and should be considered even for those within MOH-defined access areas.
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Affiliation(s)
- Tanya Guenther
- *Address correspondence to Tanya Guenther, Department of Health and Nutrition, Save the Children, 2000 L Street NW, Washington, DC 20036. E-mail:
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Mehta KM, Rerolle F, Rammohan SV, Albohm DC, Muwowo G, Moseson H, Sept L, Lee HL, Bendavid E. Systematic Motorcycle Management and Health Care Delivery: A Field Trial. Am J Public Health 2015; 106:87-94. [PMID: 26562131 DOI: 10.2105/ajph.2015.302891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated whether managed transportation improves outreach-based health service delivery to rural village populations. METHODS We examined systematic transportation management in a small-cluster interrupted time series field trial. In 8 districts in Southern Zambia, we followed health workers at 116 health facilities from September 2011 to March 2014. The primary outcome was the average number of outreach trips per health worker per week. Secondary outcomes were health worker productivity, motorcycle performance, and geographical coverage. RESULTS Systematic fleet management resulted in an increase of 0.9 (SD = 1.0) trips to rural villages per health worker per week (P < .001), village-level health worker productivity by 20.5 (SD = 5.9) patient visits, 10.2 (SD = 1.5) measles immunizations, and 5.2 (SD = 5.4) child growth assessments per health worker per week. Motorcycle uptime increased by 3.5 days per week (P < .001), use by 1.5 days per week (P < .001), and mean distance by 9.3 kilometers per trip (P < .001). Geographical coverage of health outreach increased in experimental (P < .001) but not control districts. CONCLUSIONS Systematic motorcycle management improves basic health care delivery to rural villages in resource-poor environments through increased health worker productivity and greater geographical coverage.
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Affiliation(s)
- Kala M Mehta
- Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford
| | - Francois Rerolle
- Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford
| | - Sonali V Rammohan
- Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford
| | - Davis C Albohm
- Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford
| | - George Muwowo
- Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford
| | - Heidi Moseson
- Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford
| | - Lesley Sept
- Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford
| | - Hau L Lee
- Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford
| | - Eran Bendavid
- Kala M. Mehta, Sonali V. Rammohan, and Hau L. Lee are with the Value Chain Innovation Initiative, Stanford Graduate School of Business, Stanford University, Stanford, CA. Francois Rerolle was with the Department of Civil and Environmental Engineering, Stanford University. Davis C. Albohm and Lesley Sept are with the Stanford Institute for Innovation in Developing Economies, Stanford University. George Muwowo was with the Stanford Graduate School of Business Field Office, Riders for Health Evaluation Program, Livingstone, Zambia. Kala M. Mehta and Heidi Moseson are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. Eran Bendavid is with the Department of General Medical Disciplines, Stanford University School, of Medicine Stanford
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Quantifying the impact of accessibility on preventive healthcare in sub-Saharan Africa using mobile phone data. Epidemiology 2015; 26:223-8. [PMID: 25643101 PMCID: PMC4323566 DOI: 10.1097/ede.0000000000000239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor physical access to health facilities has been identified as an important contributor to reduced uptake of preventive health services and is likely to be most critical in low-income settings. However, the relation among physical access, travel behavior, and the uptake of healthcare is difficult to quantify. METHODS Using anonymized mobile phone data from 2008 to 2009, we analyze individual and spatially aggregated travel patterns of 14,816,521 subscribers across Kenya and compare these measures to (1) estimated travel times to health facilities and (2) data on the uptake of 2 preventive healthcare interventions in an area of western Kenya: childhood immunizations and antenatal care. RESULTS We document that long travel times to health facilities are strongly correlated with increased mobility in geographically isolated areas. Furthermore, we found that in areas with equal physical access to healthcare, mobile phone-derived measures of mobility predict which regions are lacking preventive care. CONCLUSIONS Routinely collected mobile phone data provide a simple and low-cost approach to mapping the uptake of preventive healthcare in low-income settings.
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Kanté AM, Gutierrez HR, Larsen AM, Jackson EF, Helleringer S, Exavery A, Tani K, Phillips JF. Childhood Illness Prevalence and Health Seeking Behavior Patterns in Rural Tanzania. BMC Public Health 2015; 15:951. [PMID: 26399915 PMCID: PMC4581421 DOI: 10.1186/s12889-015-2264-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 09/13/2015] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION This paper identifies factors influencing differences in the prevalence of diarrhea, fever and acute respiratory infection (ARI), and health seeking behavior among caregivers of children under age five in rural Tanzania. METHODS Using cross-sectional survey data collected in Kilombero, Ulanga, and Rufiji districts, the analysis included 1,643 caregivers who lived with 2,077 children under five years old. Logistic multivariate and multinomial regressions were used to analyze factors related to disease prevalence and to health seeking behavior. RESULTS One quarter of the children had experienced fever in the past two weeks, 12.0 % had diarrhea and 6.7 % experienced ARI. Children two years of age and older were less likely to experience morbidity than children under one year [ORfever = 0.77, 95 % CI 0.61-0.96; ORdiarrhea = 0.26, 95 % CI 0.18-0.37; ORARI = 0.60 95 % CI 0.41-0.89]. Children aged two and older were more likely than children under one to receive no care or to receive care at home, rather than to receive care at a facility [RRRdiarrhea = 3.47, 95 % CI 1.19-10.17 for "No care"]. Children living with an educated caregiver were less likely to receive no care or home care rather than care at a facility as compared to those who lived with an uneducated caregiver [RRRdiarrhea = 0.28, 95 % CI 1.10-0.79 for "No care"]. Children living in the wealthiest households were less likely to receive no care or home care for fever as compared to those who lived poorest households. Children living more than 1 km from health facility were more likely to receive no care or to receive home care for diarrhea rather than care at a facility as compared to those living less than 1 km from a facility [RRRdiarrhea = 3.50, 95 % CI 1.13-10.82 for "No care"]. Finally, caregivers who lived with more than one child under age five were more likely to provide no care or home care rather than to seek treatment at a facility as compared to those living with only one child under five. CONCLUSIONS Our results suggest that child age, caregiver education attainment, and household wealth and location may be associated with childhood illness and care seeking behavior patterns. Interventions should be explored that target children and caregivers according to these factors, thereby better addressing barriers and optimizing health outcomes especially for children at risk of dying before the age of five.
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Affiliation(s)
- Almamy M Kanté
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA. .,Ifakara Health Institute, PO Box 78373, Dar es Salaam, Mikocheni, Tanzania. .,Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel, CH-4002, Switzerland. .,University of Basel, Petersplatz 1, Basel, CH-4003, Switzerland.
| | - Hialy R Gutierrez
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Anna M Larsen
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Elizabeth F Jackson
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
| | - Stéphane Helleringer
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Amon Exavery
- Ifakara Health Institute, PO Box 78373, Dar es Salaam, Mikocheni, Tanzania.
| | - Kassimu Tani
- Ifakara Health Institute, PO Box 78373, Dar es Salaam, Mikocheni, Tanzania.
| | - James F Phillips
- Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, 10032, USA.
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Obare F, Warren C, Kanya L, Abuya T, Bellows B. Community-level effect of the reproductive health vouchers program on out-of-pocket spending on family planning and safe motherhood services in Kenya. BMC Health Serv Res 2015; 15:343. [PMID: 26302826 PMCID: PMC4548901 DOI: 10.1186/s12913-015-1000-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background Although vouchers can protect individuals in low-income countries from financial catastrophe and impoverishment arising from out-of-pocket expenditures on healthcare, their effectiveness in achieving this goal depends on whether both service and transport costs are subsidized as well as other factors such as service availability in a given locality and community perceptions about the quality of care. This paper examines the community-level effect of the reproductive health vouchers program on out-of-pocket expenditure on family planning, antenatal, delivery and postnatal care services in Kenya. Methods Data are from two rounds of cross-sectional household surveys in voucher and non-voucher sites. The first survey was conducted between May 2010 and July 2011 among 2,933 women aged 15–49 years while the second survey took place between July and October 2012 among 3,094 women of similar age groups. The effect of the program on out-of-pocket expenditure is determined by difference-in-differences estimation. Analysis entails comparison of changes in proportions, means and medians as well as estimation of multivariate linear regression models with interaction terms between indicators for study site (voucher or non-voucher) and period of study (2010–2011 or 2012). Results There were significantly greater declines in the proportions of women from voucher sites that paid for antenatal, delivery and postnatal care services at health facilities compared to those from non-voucher sites. The changes were also consistent with increased uptake of the safe motherhood voucher in intervention sites over time. There was, however, no significant difference in changes in the proportions of women from voucher and non-voucher sites that paid for family planning services. The results further show that there were significant differences in changes in the amount paid for family planning and antenatal care services by women from voucher compared to those from non-voucher sites. Although there were greater declines in the average amount paid for delivery and postnatal care services by women from voucher compared to those from non-voucher sites, the difference-in-differences estimates were not statistically significant. Conclusions The reproductive health vouchers program in Kenya significantly contributed to reductions in the proportions of women in the community that paid out-of-pocket for safe motherhood services at health facilities.
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Affiliation(s)
- Francis Obare
- Reproductive Health Program, Population Council, Ralph Bunche Road, General Accident House, P.O. Box 17643, Nairobi, 00500, Kenya.
| | - Charlotte Warren
- Reproductive Health Program, Population Council, 4301 Connecticut Avenue, Washington, DC, NW, 20008, USA.
| | - Lucy Kanya
- Brunel University London, Kingston Lane, Uxbridge, UB83PH, London.
| | - Timothy Abuya
- Reproductive Health Program, Population Council, Ralph Bunche Road, General Accident House, P.O. Box 17643, Nairobi, 00500, Kenya.
| | - Ben Bellows
- Reproductive Health Program, Population Council, Ralph Bunche Road, General Accident House, P.O. Box 17643, Nairobi, 00500, Kenya.
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El Bcheraoui C, Tuffaha M, Daoud F, Kravitz H, AlMazroa MA, Al Saeedi M, Memish ZA, Basulaiman M, Al Rabeeah AA, Mokdad AH. Access and barriers to healthcare in the Kingdom of Saudi Arabia, 2013: findings from a national multistage survey. BMJ Open 2015; 5:e007801. [PMID: 26070798 PMCID: PMC4466760 DOI: 10.1136/bmjopen-2015-007801] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/01/2015] [Accepted: 05/08/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES We analysed data from a large household survey to identify barriers to healthcare in the Kingdom of Saudi Arabia. METHODS The Saudi Health Interview Survey (SHIS) is a national multistage survey of individuals aged 15 years or older. The survey combined a household questionnaire and a laboratory blood analysis. We used a backward elimination multivariate logistic regression model to measure association between (1) diagnosis, (2) treatment, and (3) control of hypertension or diabetes and sociodemographic factors, history of diagnosis with chronic conditions, and type of, and distance travelled to, the clinic last visited. RESULTS Between April and June 2013, a total of 10,735 participants completed SHIS and were invited to the local health clinics. Among hypertensive individuals, women, older individuals, and those previously diagnosed with diabetes and hypercholesterolaemia were more likely to have been diagnosed with hypertension than their counterparts. Among participants diagnosed with hypertension, the likelihood of being treated increased with age and education. The likelihood of having uncontrolled blood pressure despite treatment increased with education and a history of diagnosis with hypercholesterolaemia. Type of clinic visited and distance travelled to last clinic visit were not associated with diagnosis or treatment of hypertension or control of blood pressure. Similar factors were associated with the likelihood of diagnosis and treatment among individuals with diabetes. Having uncontrolled glycated haemoglobin levels, despite treatment, was less common among those who visited governmental clinics other than those of the Ministry of Health, compared with those who visited Ministry clinics. CONCLUSIONS Our findings highlight the importance of individual characteristics in healthcare-seeking practices rather than system-based potential barriers. Saudis seem to mostly seek healthcare when sick. Hence, the Saudi Ministry of Health needs to implement a comprehensive plan including health education and investigations, to understand the barriers and bottlenecks to healthcare-seeking behaviour.
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Affiliation(s)
- Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Marwa Tuffaha
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Hannah Kravitz
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | | | | | - Ziad A Memish
- Ministry of Health of the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
| | | | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
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Darrouzet-Nardi AF, Masters WA. Urbanization, market development and malnutrition in farm households: evidence from the Demographic and Health Surveys, 1986–2011. Food Secur 2015. [DOI: 10.1007/s12571-015-0470-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Schoeps A, Kynast-Wolf G, Nesbitt RC, Müller O, Sié A, Becher H. Decreasing disparities in infant survival using surveillance data from Burkina Faso. Am J Trop Med Hyg 2015; 92:1038-44. [PMID: 25802428 DOI: 10.4269/ajtmh.14-0390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 01/19/2015] [Indexed: 11/07/2022] Open
Abstract
We assessed changes in the effect size of risk factors for infant mortality comparing a birth cohort from 2005 to 2010 with a birth cohort from 1993 to 1999 in the Nouna Health and Demographic Surveillance System (HDSS) in Burkina Faso. Single- and three-level Cox proportional hazards regression models were used for analysis. Independent variables among others included year of birth, ethnicity, religion, age of the mother, birth order, death of the mother, being a twin, and distance to the closest health facility. We observed an infant mortality rate of about 51/1,000 person-years. The strongest risk factors were death of the mother and being a twin, which were also the strongest risk factors from the previous analysis period. Compared with the period 1993-1999, the effect of most risk factors decreased, notably ethnicity, religious affiliation, distance to the closest health facility, birth order, and season of birth. The strongest reduction in mortality occurred in the groups with the previously highest infant mortality rates in 1993-1999.
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Affiliation(s)
- Anja Schoeps
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Centre de Recherche on Santé de Nouna (CRSN), Nouna, Burkina Faso; University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Gisela Kynast-Wolf
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Centre de Recherche on Santé de Nouna (CRSN), Nouna, Burkina Faso; University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Robin C Nesbitt
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Centre de Recherche on Santé de Nouna (CRSN), Nouna, Burkina Faso; University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Olaf Müller
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Centre de Recherche on Santé de Nouna (CRSN), Nouna, Burkina Faso; University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ali Sié
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Centre de Recherche on Santé de Nouna (CRSN), Nouna, Burkina Faso; University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Heiko Becher
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany; Centre de Recherche on Santé de Nouna (CRSN), Nouna, Burkina Faso; University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Quattrochi J, Jasseh M, Mackenzie G, Castro MC. Spatial analysis of under-5 mortality and potential risk factors in the Basse Health and Demographic Surveillance System, the Gambia. Trop Med Int Health 2015; 20:941-51. [PMID: 25728631 DOI: 10.1111/tmi.12490] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the spatial pattern in under-5 mortality rates in the Basse Health and Demographic Surveillance System (BHDSS) and to test for associations between under-5 deaths and biodemographic and socio-economic risk factors. METHODS Using data on child survival from 2007 to 2011 in the BHDSS, we mapped under-5 mortality by km(2) . We tested for spatial clustering of high or low death rates using Kulldorff's spatial scan statistic. Associations between child death and a variety of biodemographic and socio-economic factors were assessed with Cox proportional hazards models, and deviance residuals from the best-fitting model were tested for spatial clustering. RESULTS The overall death rate among children under 5 was 0.0195 deaths per child-year. We found two spatial clusters of high death rates and one spatial cluster of low death rates; children in the two high clusters died at a rate of 0.0264 and 0.0292 deaths per child-year, while in the low cluster, the rate was 0.0144 deaths per child-year. We also found that children born to Fula mothers experienced, on average, a higher hazard of death, whereas children born in the households in the upper two quintiles of asset ownership experienced, on average, a lower hazard of death. After accounting for the spatial distribution of biodemographic and socio-economic characteristics, we found no residual spatial pattern in child mortality risk. CONCLUSION This study demonstrates that significant inequality in under-5 death rates can occur within a relatively small area (1100 km(2) ). Risks of under-5 mortality were associated with mother's ethnicity and household wealth. If high mortality clusters persist, then equity concerns may require additional public health efforts in those areas.
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Cabieses B, Bird P. Glossary of access to health care and related concepts for low- and middle-income countries (LMICs): a critical review of international literature. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 44:845-61. [PMID: 25626232 DOI: 10.2190/hs.44.4.j] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Access to health care is a multidimensional and complex concept. Achieving equitable access to care is an important goal for all countries, but particularly challenging in Low- and Middle-Income Countries (LMICs). Despite wide use of the concept of access, it continues to be defined and measured in very different ways. This glossary is a structured overview of key definitions for concepts related to access to health care, with special focus on the interpretation for LMICs. It aims to help people with interest in health service delivery to draw an overview and provide some pointers for further reading in both conceptual and empirical advances in access to health care in LMICs. This document is structured in five sections. The first introduces a general description of the concept of access to health care and its relevance to LMICs, the second displays the search conducted on access to health care for LMICs and the framework used for presentation of glossary terms, the third describes theoretical models most frequently used in the past when looking at access to health care in LMICs, the fourth is the list of terms, and the final section is a discussion of the most salient aspects of this critical review.
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Kanté AM, Nathan R, Jackson EF, Levira F, Helleringer S, Masanja H, Phillips JF. Trends in socioeconomic disparities in a rapid under-five mortality transition: a longitudinal study in the United Republic of Tanzania. Bull World Health Organ 2015; 94:258-66A. [PMID: 27034519 PMCID: PMC4794298 DOI: 10.2471/blt.15.154658] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 10/01/2015] [Accepted: 11/27/2015] [Indexed: 11/30/2022] Open
Abstract
Objective To explore trends in socioeconomic disparities and under-five mortality rates in rural parts of the United Republic of Tanzania between 2000 and 2011. Methods We used longitudinal data on births, deaths, migrations, maternal educational attainment and household characteristics from the Ifakara and Rufiji health and demographic surveillance systems. We estimated hazard ratios (HR) for associations between mortality and maternal educational attainment or relative household wealth, using Cox hazard regression models. Findings The under-five mortality rate declined in Ifakara from 132.7 deaths per 1000 live births (95% confidence interval, CI: 119.3–147.4) in 2000 to 66.2 (95% CI: 59.0–74.3) in 2011 and in Rufiji from 118.4 deaths per 1000 live births (95% CI: 107.1–130.7) in 2000 to 76.2 (95% CI: 66.7–86.9) in 2011. Combining both sites, in 2000–2001, the risk of dying for children of uneducated mothers was 1.44 (95% CI: 1.08–1.92) higher than for children of mothers who had received education beyond primary school and in 2010–2011, the HR was 1.18 (95% CI: 0.90–1.55). In contrast, mortality disparities between richest and poorest quintiles worsened in Rufiji, from 1.20 (95% CI: 0.99–1.47) in 2000–2001 to 1.48 (95% CI: 1.15–1.89) in 2010–2011, while in Ifakara, disparities narrowed from 1.30 (95% CI: 1.09–1.55) to 1.15 (95% CI: 0.95–1.39) in the same period. Conclusion While childhood survival has improved, mortality disparities still persist, suggesting a need for policies and programmes that both reduce child mortality and address socioeconomic disparities.
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Affiliation(s)
- Almamy Malick Kanté
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue (B2), New York, NY 10032, United States of America (USA)
| | - Rose Nathan
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Elizabeth F Jackson
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue (B2), New York, NY 10032, United States of America (USA)
| | - Francis Levira
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Honorati Masanja
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - James F Phillips
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Avenue (B2), New York, NY 10032, United States of America (USA)
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A cohort study of morbidity, mortality and health seeking behavior following rural health center visits by children under 12 in southwestern Uganda. PLoS One 2015; 10:e0118055. [PMID: 25635947 PMCID: PMC4311987 DOI: 10.1371/journal.pone.0118055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 12/21/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children discharged from hospitals in developing countries are at high risk of morbidity and mortality. However, few data describe these outcomes among children seen and discharged from rural outpatient centers. OBJECTIVE The objective of this exploratory study was to identify predictors of immediate and follow-up morbidity and mortality among children visiting a rural health center in Uganda. METHODS Subjects 0-12 years of age seeking care with a caregiver were consecutively enrolled from a single rural health center in Southwestern Uganda. Baseline variables were collected by research nurses and outcomes of referral, admission or death were recorded (immediate events). Death, hospital admission and health seeking occurring during the 30 days following the clinic visit were also determined (follow-up events). Univariate logistic regression was performed to identify baseline variables associated with immediate outcome and follow-up outcomes. RESULTS Over the four-month recruitment period 717 subjects were enrolled. There were 85 (11.9%) immediate events (10.1% were admitted, 2.2% were referred, none died). Forty-seven (7.8%) events occurred within 30 days after the visit (7.3% sought care from a health provider, 1.5% were admitted and 0.5% died). Variables associated with immediate events included living more than 30 minutes from the health center, age older than 5 years, having received an antimalarial prior to the visit, having seen a community health worker prior to the visit, elevated respiratory rate or temperature, and depressed weight-for-age z score or decreased oxygen saturation. These variables were not associated with follow-up events. CONCLUSIONS Sick-child visits at a rural health center in South Western Uganda were associated with rates of mortality and subsequent admission of less than 2% in the period following the sick child visits. Other types of health seeking behavior occurred in approximately 7% of subjects during this same period. Several variables were associated with immediate events but there were no reliable predictors of follow-up events, possibly due to low statistical power.
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Liew HP, Gardner S. Determinants of patient satisfaction with outpatient care in Indonesia: A conjoint analysis approach. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2014.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Mee P, Collinson MA, Madhavan S, Kabudula C, Gómez-Olivé FX, Kahn K, Tollman SM, Hargreaves J, Byass P. Determinants of the risk of dying of HIV/AIDS in a rural South African community over the period of the decentralised roll-out of antiretroviral therapy: a longitudinal study. Glob Health Action 2014; 7:24826. [PMID: 25416322 PMCID: PMC4245451 DOI: 10.3402/gha.v7.24826] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 01/09/2023] Open
Abstract
Background Antiretroviral treatment (ART) has significantly reduced HIV mortality in South Africa. The benefits have not been experienced by all groups. Here we investigate the factors associated with these inequities. Design This study was located in a rural South African setting and used data collected from 2007 to 2010, the period when decentralised ART became available. Approximately one-third of the population were of Mozambican origin. There was a pattern of repeated circular migration between urban areas and this community. Survival analysis models were developed to identify demographic, socioeconomic, and spatial risk factors for HIV mortality. Results Among the study population of 105,149 individuals, there were 2,890 deaths. The HIV/TB mortality rate decreased by 27% between 2007–2008 and 2009–2010. For other causes of death, the reduction was 10%. Bivariate analysis found that the HIV/TB mortality risk was lower for: those living within 5 km of the Bhubezi Community Health Centre; women; young adults; in-migrants with a longer period of residence; permanent residents; and members of households owning motorised transport, holding higher socioeconomic positions, and with higher levels of education. Multivariate modelling showed, in addition, that those with South Africa as their country of origin had an increased risk of HIV/TB mortality compared to those with Mozambican origins. For males, those of South African origin, and recent in-migrants, the risk of death associated with HIV/TB was significantly greater than that due to other causes. Conclusions In this community, a combination of factors was associated with an increased risk of dying of HIV/TB over the period of the roll-out of ART. There is evidence for the presence of barriers to successful treatment for particular sub-groups in the population, which must be addressed if the recent improvements in population-level mortality are to be maintained.
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Affiliation(s)
- Paul Mee
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK;
| | - Mark A Collinson
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - Sangeetha Madhavan
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of African-American Studies, University of Maryland-College Park, College Park, MD, USA
| | - Chodziwadziwa Kabudula
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - Francesc Xavier Gómez-Olivé
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - Stephen M Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden; International Network for the Demographic Evaluation of Populations and Their Health (INDEPTH) Network, Accra, Ghana
| | - James Hargreaves
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Byass
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; WHO Collaborating Centre for Verbal Autopsy, Umeå Centre for Global Health Research, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Glatman-Freedman A, Nichols K. The effect of social determinants on immunization programs. Hum Vaccin Immunother 2014; 8:293-301. [DOI: 10.4161/hv.19003] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Barogui YT, Sopoh GE, Johnson RC, de Zeeuw J, Dossou AD, Houezo JG, Chauty A, Aguiar J, Agossadou D, Edorh PA, Asiedu K, van der Werf TS, Stienstra Y. Contribution of the community health volunteers in the control of Buruli ulcer in Bénin. PLoS Negl Trop Dis 2014; 8:e3200. [PMID: 25275562 PMCID: PMC4183479 DOI: 10.1371/journal.pntd.0003200] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 08/19/2014] [Indexed: 11/15/2022] Open
Abstract
Background Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually BU begins as a painless nodule, plaque or edema, ultimately developing into an ulcer. The high number of patients presenting with ulcers in an advanced stage is striking. Such late presentation will complicate treatment and have long-term disabilities as a consequence. The disease is mainly endemic in West Africa. The primary strategy for control of this disease is early detection using community village volunteers. Methodology/Principal Findings In this retrospective, observational study, information regarding Buruli ulcer patients that reported to one of the four BU centers in Bénin between January 2008 and December 2010 was collected using the WHO/BU01 forms. Information used from these forms included general characteristics of the patient, the results of diagnostic tests, the presence of functional limitations at start of treatment, lesion size, patient delay and the referral system. The role of the different referral systems on the stage of disease at presentation in the hospital was analyzed by a logistic regression analysis. About a quarter of the patients (26.5%) were referred to the hospital by the community health volunteers. In our data set, patients referred to the hospital by community health volunteers appeared to be in an earlier stage of disease than patients referred by other methods, but after adjustment by the regression analysis for the health center, this effect could no longer be seen. The Polymerase Chain Reaction (PCR) for IS2404 positivity rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems. Conclusions/Significance This study clarifies the role played by community health volunteers in Bénin, and shows that they play an important role in the control of BU. Buruli ulcer (BU) is a neglected tropical disease caused by Mycobacterium ulcerans. Usually, the number of patients presenting with ulcers in an advanced stage is high. This complicates treatment and increases the risk of disabilities. The disease is endemic mainly in West Africa. The primary strategy for control is early detection using community village volunteers. In Bénin, data was collected to understand the role of the different referral systems on the stage of disease at presentation in the hospital and the diagnostic precision. About a quarter of the patients were referred to the hospital by the community health volunteers. Community health volunteers referred patients more frequently in an earlier stage of disease. The PCR confirmation rate among patients referred by the community health volunteers was not systematically lower than in patients referred by other systems. We found that community health volunteers played an important role in the referral system of BU patients in Bénin. This information is relevant for health care programs attempting to control BU but may also be relevant for health care programs working on other diseases in areas with restricted resources.
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Affiliation(s)
- Yves Thierry Barogui
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli de Lalo, Ministère de la Santé, Cotonou, Bénin
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Ghislain Emmanuel Sopoh
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministère de la Santé, Cotonou, Bénin
| | - Roch Christian Johnson
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Janine de Zeeuw
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ange Dodji Dossou
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministère de la Santé, Cotonou, Bénin
| | - Jean Gabin Houezo
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli d'Allada, Ministère de la Santé, Cotonou, Bénin
| | - Annick Chauty
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli de Pobè, Ministère de la Santé, Cotonou, Bénin
| | - Julia Aguiar
- Centre de Dépistage et de Traitement de l'Ulcère de Buruli de Zangnanado, Ministère de la Santé, Cotonou, Bénin
| | - Didier Agossadou
- Programme National de Lutte Contre la Lèpre et l'Ulcère de Buruli, Ministère de la Santé, Cotonou, Bénin
| | - Patrick A. Edorh
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d'Abomey-Calavi, Abomey-Calavi, Bénin
| | - Kingsley Asiedu
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Tjip S. van der Werf
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Skaftun EK, Ali M, Norheim OF. Understanding inequalities in child health in Ethiopia: health achievements are improving in the period 2000-2011. PLoS One 2014; 9:e106460. [PMID: 25166860 PMCID: PMC4148443 DOI: 10.1371/journal.pone.0106460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/04/2014] [Indexed: 11/30/2022] Open
Abstract
Objective In Ethiopia, coverage of key health services is low, and community based services have been implemented to improve access to key services. This study aims to describe and assess the level and the distribution of health outcomes and coverage for key services in Ethiopia, and their association with socioeconomic and geographic determinants. Methods Data were obtained from the 2000, 2005 and 2011 Ethiopian Demographic and Health Surveys. As indicators of access to health care, the following variables were included: Under-five and neonatal deaths, skilled birth attendance, coverage of vaccinations, oral rehydration therapy for diarrhoea, and antibiotics for suspected pneumonia. For each of the indicators in 2011, inequality was described by estimating their concentration index and a geographic Gini index. For further assessment of the inequalities, the concentration indices were decomposed. An index of health achievement, integrating mean coverage and the distribution of coverage, was estimated. Changes from 2000 to 2011 in coverage, inequality and health achievement were assessed. Results Significant pro-rich inequalities were found for all indicators except treatment for suspected pneumonia in 2011. The geographic Gini index showed significant regional inequality for most indicators. The decomposition of the 2011 concentration indices revealed that the factor contributing the most to the observed inequalities was different levels of wealth. The mean of all indicators improved from 2000 to 2011, and the health achievement index improved for most indicators. The socioeconomic inequalities seem to increase from 2000 to 2011 for under-five and neonatal deaths, whereas they are stable or decreasing for the other indicators. Conclusion There is an unequal socioeconomic and geographic distribution of health and access to key services in Ethiopia. Although the health achievement indices improved for most indicators from 2000 to 2011, socioeconomic determinants need to be addressed in order to achieve better and more fairly distributed health.
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Affiliation(s)
- Eirin Krüger Skaftun
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Merima Ali
- Chr. Michelsen Institute, Bergen, Norway
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Schoeps A, Souares A, Niamba L, Diboulo E, Kynast-Wolf G, Müller O, Sié A, Becher H. Childhood mortality and its association with household wealth in rural and semi-urban Burkina Faso. Trans R Soc Trop Med Hyg 2014; 108:639-47. [PMID: 25129891 DOI: 10.1093/trstmh/tru124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between household wealth and under-5 year mortality in rural and semi-urban Burkina Faso. METHODS The study included 15 543 children born between 2005 and 2010 in the Nouna Health and Demographic Surveillance System. Information on household wealth was collected in 2009. Two separate wealth indicators were calculated by principal components analysis for the rural and the semi-urban households, which were then divided into quintiles accordingly. Multivariable Cox proportional hazards regression was used to study the effect of the respective wealth measure on under-5 mortality. RESULTS We observed 1201 childhood deaths, corresponding to 5-year survival probability of 93.6% and 88% in the semi-urban and rural area, respectively. In the semi-urban area, household wealth was significantly related to under-5 mortality after adjustment for confounding. There was a similar but non-significant effect of household wealth on infant mortality, too. There was no effect of household wealth on under-5 mortality in rural children. CONCLUSIONS Results from this study indicate that the more privileged children from the semi-urban area with access to piped water and electricity have an advantage in under-5 survival, while under-5 mortality in the rural area is rather homogeneous and still relatively high.
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Affiliation(s)
- Anja Schoeps
- Institute of Public Health, University of Heidelberg, 69120 Heidelberg, Germany
| | - Aurélia Souares
- Institute of Public Health, University of Heidelberg, 69120 Heidelberg, Germany
| | - Louis Niamba
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso Département de Démographie, Université de Montréal, H3T 1N8 Montréal, Canada
| | - Eric Diboulo
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso Swiss Tropical and Public Health Institute (Swiss TPH), 4051 Basel, Switzerland
| | - Gisela Kynast-Wolf
- Institute of Public Health, University of Heidelberg, 69120 Heidelberg, Germany
| | - Olaf Müller
- Institute of Public Health, University of Heidelberg, 69120 Heidelberg, Germany
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Heiko Becher
- Institute of Public Health, University of Heidelberg, 69120 Heidelberg, Germany
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The effect of distance on observed mortality, childhood pneumonia and vaccine efficacy in rural Gambia. Epidemiol Infect 2014; 142:2491-500. [DOI: 10.1017/s0950268814000314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYWe investigated whether straight-line distance from residential compounds to healthcare facilities influenced mortality, the incidence of pneumonia and vaccine efficacy against pneumonia in rural Gambia. Clinical surveillance for pneumonia was conducted on 6938 children living in the catchment areas of the two largest healthcare facilities. Deaths were monitored by three-monthly home visits. Children living >5 km from the two largest healthcare facilities had a 2·78 [95% confidence interval (CI) 1·74–4·43] times higher risk of all-cause mortality compared to children living within 2 km of these facilities. The observed rate of clinical and radiological pneumonia was lower in children living >5 km from these facilities compared to those living within 2 km [rate ratios 0·65 (95% CI 0·57–0·73) and 0·74 (95% CI 0·55–0·98), respectively]. There was no association between distance and estimated pneumococcal vaccine efficacy. Geographical access to healthcare services is an important determinant of survival and pneumonia in children in rural Gambia.
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Krumkamp R, Sarpong N, Kreuels B, Ehlkes L, Loag W, Schwarz NG, Zeeb H, Adu-Sarkodie Y, May J. Health care utilization and symptom severity in Ghanaian children--a cross-sectional study. PLoS One 2013; 8:e80598. [PMID: 24244698 PMCID: PMC3828249 DOI: 10.1371/journal.pone.0080598] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/07/2013] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to identify factors influencing health care utilization behavior for children with mild or severe disease symptoms in rural Ghana. Between March and September 2008 a cross-sectional health care utilization survey was conducted and 8,715 caregivers were interviewed regarding their intended behavior in case their children had mild or severe fever or diarrhea. To show associations between hospital attendance and further independent factors (e.g. travel distance or socio-economic status) prevalence ratios were calculated for the four disease symptoms. A Poisson regression model was used to control for potential confounding. Frequency of hospital attendance decreased constantly with increasing distance to the health facility. Being enrolled in the national health insurance scheme increased the intention to attend a hospital. The effect of the other factors diminished in the Poisson regression if modeled together with travel distance. The observed associations weakened with increasing severity of symptoms, which indicates that barriers to visit a hospital are less important if children experience a more serious illness. As shown in other studies, travel distance to a health care provider had the strongest effect on health care utilization. Studies to identify local barriers to access health care services are important to inform health policy making as they identify deprived populations with low access to health services and to early treatment.
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Affiliation(s)
- Ralf Krumkamp
- Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
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Ridde V, Haddad S, Heinmüller R. Improving equity by removing healthcare fees for children in Burkina Faso. J Epidemiol Community Health 2013; 67:751-7. [PMID: 23776054 PMCID: PMC3756435 DOI: 10.1136/jech-2012-202080] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 02/05/2013] [Accepted: 03/30/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study evaluated the effects on healthcare access inequities of an intervention exempting children under 5 years from user fees in Burkina Faso. METHODS The design consisted of two complementary studies. The first was an interrupted time series (56 months before and 12 months after) study of daily curative consultations according to distance (<5, 5-9 and ≥10 km) in a stratified random sample of 18 health centres: 12 with the intervention and 6 without. The second was a household panel survey (n=1214) assessing the evolution of health-seeking behaviours. Multilevel regression was used throughout. RESULTS Attendance doubled under the intervention, after adjusting for Centres de Santé et de Promotion Sociale size, districts, secular trend and seasonal variation. Utilisation increased for all distance ranges and in all of the 12 health centres of the intervention area. The exemption benefited all children (rate ratios (RR)=1.52 (1.23 to 1.88)), whether their health needs were high (RR=1.69 (1.22 to 2.32)) or not (RR=1.46 (1.10 to 1.93)) and whether the children lived near (RR=1.42 (1.09 to 1.85)) or far from a health centre (RR=1.79 (1.31 to 2.43)). The exemption benefited the children of poor families when health need was high and services near (RR=5.23; (1.30 to 20.99)). The amount saved for a child's treatment by the exemption was on average and median 2500 F CFA (≈US$5). CONCLUSIONS Exempting children under five from user fees is effective and helps reduce inequities of access. It benefits vulnerable populations, although their service utilisation remains constrained by limitations in geographic accessibility of services.
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Affiliation(s)
- V Ridde
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.
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Skiles MP, Burgert CR, Curtis SL, Spencer J. Geographically linking population and facility surveys: methodological considerations. Popul Health Metr 2013; 11:14. [PMID: 23926907 PMCID: PMC3765268 DOI: 10.1186/1478-7954-11-14] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 08/05/2013] [Indexed: 11/16/2022] Open
Abstract
Background The relationship between health services and population outcomes is an important area of public health research that requires bringing together data on outcomes and the relevant service environment. Linking independent, existing datasets geographically is potentially an efficient approach; however, it raises a number of methodological issues which have not been extensively explored. This sensitivity analysis explores the potential misclassification error introduced when a sample rather than a census of health facilities is used and when household survey clusters are geographically displaced for confidentiality. Methods Using the 2007 Rwanda Service Provision Assessment (RSPA) of all public health facilities and the 2007–2008 Rwanda Interim Demographic and Health Survey (RIDHS), five health facility samples and five household cluster displacements were created to simulate typical SPA samples and household cluster datasets. Facility datasets were matched with cluster datasets to create 36 paired datasets. Four geographic techniques were employed to link clusters with facilities in each paired dataset. The links between clusters and facilities were operationalized by creating health service variables from the RSPA and attaching them to linked RIDHS clusters. Comparisons between the original facility census and undisplaced clusters dataset with the multiple samples and displaced clusters datasets enabled measurement of error due to sampling and displacement. Results Facility sampling produced larger misclassification errors than cluster displacement, underestimating access to services. Distance to the nearest facility was misclassified for over 50% of the clusters when directly linked, while linking to all facilities within an administrative boundary produced the lowest misclassification error. Measuring relative service environment produced equally poor results with over half of the clusters assigned to the incorrect quintile when linked with a sample of facilities and more than one-third misclassified due to displacement. Conclusions At low levels of geographic disaggregation, linking independent facility samples and household clusters is not recommended. Linking facility census data with population data at the cluster level is possible, but misclassification errors associated with geographic displacement of clusters will bias estimates of relationships between service environment and health outcomes. The potential need to link facility and population-based data requires consideration when designing a facility survey.
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Affiliation(s)
- Martha Priedeman Skiles
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 W Franklin St, Chapel Hill, NC 27516, USA
| | - Clara R Burgert
- ICF International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA
| | - Siân L Curtis
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 W Franklin St, Chapel Hill, NC 27516, USA
| | - John Spencer
- Carolina Population Center, University of North Carolina at Chapel Hill, 206 W Franklin St, Chapel Hill, NC 27516, USA
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GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda. AIDS 2013; 27:1503-8. [PMID: 23435294 DOI: 10.1097/qad.0b013e32835fd873] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Studies of the association between transportation barriers and HIV-related health outcomes have shown both positive and negative effects, possibly because a reliable, validated measure of transportation barriers has not been identified. DESIGN Prospective cohort study of HIV-infected patients in rural Uganda. METHODS Participants were enrolled from the HIV clinic at the regional referral hospital in Mbarara, Uganda as part of the Uganda AIDS Rural Treatment Outcomes (UARTO) Study. We collected the following measures of transportation barriers to HIV clinic: global positioning systems (GPS)-tracked distance measured by driving participants to their homes along their typical route; straight-line GPS distance from clinic to home, calculated with the Great Circle Formula; self-reported travel time; and self-reported travel cost. We assessed inter-measure agreement using linear regression, correlation coefficients and κ statistics (by measure quartile) and validated measures by fitting linear regression models to estimate associations with days late for clinic visits. RESULTS One hundred and eighty-eight participants were tracked with GPS. Seventy-six percent were women, with a median age of 40 years and median CD4 cell count of 193 cells/μl. We found a high correlation between GPS-based distance measures (β=0.74, P<0.001, R²=0.92, κ=0.73), but little correlation between GPS-based and self-reported measures (all R²≤0.4). GPS-based measures were associated with days late to clinic (P<0.001); but neither self-reported measure was associated (P>0.85). CONCLUSION GPS-measured distance to clinic is associated with HIV clinic absenteeism and should be prioritized over self-reported measures to optimally risk-stratify patients accessing care in rural, resource-limited settings.
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96
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Cunnington AJ, Bretscher MT, Nogaro SI, Riley EM, Walther M. Comparison of parasite sequestration in uncomplicated and severe childhood Plasmodium falciparum malaria. J Infect 2013; 67:220-30. [PMID: 23623771 PMCID: PMC3744804 DOI: 10.1016/j.jinf.2013.04.013] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/13/2013] [Accepted: 04/15/2013] [Indexed: 12/31/2022]
Abstract
Objectives To determine whether sequestration of parasitized red blood cells differs between children with uncomplicated and severe Plasmodium falciparum malaria. Methods We quantified circulating-, total- and sequestered-parasite biomass, using a mathematical model based on plasma concentration of P. falciparum histidine rich protein 2, in Gambian children with severe (n = 127) and uncomplicated (n = 169) malaria. Results Circulating- and total-, but not sequestered-, parasite biomass estimates were significantly greater in children with severe malaria than in those with uncomplicated malaria. Sequestered biomass estimates in children with hyperlactataemia or prostration were similar to those in uncomplicated malaria, whereas sequestered biomass was higher in patients with severe anaemia, and showed a trend to higher values in cerebral malaria and fatal cases. Blood lactate concentration correlated with circulating- and total-, but not sequestered parasite biomass. These findings were robust after controlling for age, prior antimalarial treatment and clonality of infection, and over a realistic range of variation in model parameters. Conclusion Extensive sequestration is not a uniform requirement for severe paediatric malaria. The pathophysiology of hyperlactataemia and prostration appears to be unrelated to sequestered parasite biomass. Different mechanisms may underlie different severe malaria syndromes, and different therapeutic strategies may be required to improve survival.
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Affiliation(s)
- Aubrey J Cunnington
- Department of Immunology and Infection, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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97
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Lohela TJ, Campbell OMR, Gabrysch S. Distance to care, facility delivery and early neonatal mortality in Malawi and Zambia. PLoS One 2012; 7:e52110. [PMID: 23300599 PMCID: PMC3531405 DOI: 10.1371/journal.pone.0052110] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 11/15/2012] [Indexed: 01/15/2023] Open
Abstract
Background Globally, approximately 3 million babies die annually within their first month. Access to adequate care at birth is needed to reduce newborn as well as maternal deaths. We explore the influence of distance to delivery care and of level of care on early neonatal mortality in rural Zambia and Malawi, the influence of distance (and level of care) on facility delivery, and the influence of facility delivery on early neonatal mortality. Methods and Findings National Health Facility Censuses were used to classify the level of obstetric care for 1131 Zambian and 446 Malawian delivery facilities. Straight-line distances to facilities were calculated for 3771 newborns in the 2007 Zambia DHS and 8842 newborns in the 2004 Malawi DHS. There was no association between distance to care and early neonatal mortality in Malawi (OR 0.97, 95%CI 0.58–1.60), while in Zambia, further distance (per 10 km) was associated with lower mortality (OR 0.55, 95%CI 0.35–0.87). The level of care provided in the closest facility showed no association with early neonatal mortality in either Malawi (OR 1.02, 95%CI 0.90–1.16) or Zambia (OR 1.02, 95%CI 0.82–1.26). In both countries, distance to care was strongly associated with facility use for delivery (Malawi: OR 0.35 per 10km, 95%CI 0.26–0.46). All results are adjusted for available confounders. Early neonatal mortality did not differ by frequency of facility delivery in the community. Conclusions While better geographic access and higher level of care were associated with more frequent facility delivery, there was no association with lower early neonatal mortality. This could be due to low quality of care for newborns at health facilities, but differential underreporting of early neonatal deaths in the DHS is an alternative explanation. Improved data sources are needed to monitor progress in the provision of obstetric and newborn care and its impact on mortality.
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Affiliation(s)
- Terhi J. Lohela
- Department of Anaesthesiology and Intensive Care Medicine, Jorvi Hospital, Helsinki University Hospital, Espoo, Finland
- University of Heidelberg, Institute of Public Health, Heidelberg, Germany
| | - Oona M. R. Campbell
- London School of Hygiene & Tropical Medicine, Faculty of Epidemiology and Population Health, London, United Kingdom
| | - Sabine Gabrysch
- University of Heidelberg, Institute of Public Health, Heidelberg, Germany
- * E-mail:
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98
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Abstract
Birth seasonality responds to a variety of environmental and socio-cultural factors. The present study was carried out to quantify the trends in seasonal variation in birth rate in seven districts in the Kayes region of Mali between 2007 and 2010 and to attempt to link climatic- and agricultural-cycle-dependent factors with birth seasonality. Lagged regression analysis based on time series analysis techniques was used to investigate seasonality of births registered in health facilities and its association with climate, labour migration, agriculture workload, malaria infection and food supply. There was a clear bimodal pattern in month-to-month institutional delivery rate variation, and this seasonal pattern repeated each year over the study period. The data showed that rates of health-facility-attended deliveries were high at the end of the dry season (April-June), fell rapidly in the first half of the rainy season, rose again during the later part of the rainy season (August-October) and fell to their lowest values after the rains. The first peak observed in spring (April-June) corresponded to conception nine months earlier during the rainy season (between July and September), while the second peak observed in the third quarter of the year (August-October) corresponded with conception at the beginning of the dry season right after the harvest period (between November and January). Between these peaks was an abrupt trough in July. The findings support a causal process through which climate change influences conception/birth seasonality in two direct and indirect pathways. On one side climate change influences conception/birth seasonality from the effects on fetal loss (changes in annual rainfall leading to changes in malaria incidence) and on the other side by affecting fecundability (changes in agricultural cycles leading to changes in food production, agricultural workload and socio-cultural events, which in turn influence energy balance and sexual behaviour). Labour migration, which is closely linked with the agricultural cycle, influences sexual intercourse and thus marital fertility. Finally, the model emphasizes an eco-systemic approach to the study of birth seasonality.
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99
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Kadobera D, Sartorius B, Masanja H, Mathew A, Waiswa P. The effect of distance to formal health facility on childhood mortality in rural Tanzania, 2005-2007. Glob Health Action 2012; 5:1-9. [PMID: 23151364 PMCID: PMC3495250 DOI: 10.3402/gha.v5i0.19099] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/15/2012] [Accepted: 10/18/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Major improvements are required in the coverage and quality of essential childhood interventions to achieve Millennium Development Goal Four (MDG 4). Long distance to health facilities is one of the known barriers to access. We investigated the effect of networked and Euclidean distances from home to formal health facilities on childhood mortality in rural Tanzania between 2005 and 2007. METHODS A secondary analysis of data from a cohort of 28,823 children younger than age 5 between 2005 and 2007 from Ifakara Health and Demographic Surveillance System was carried out. Both Euclidean and networked distances from the household to the nearest health facility were calculated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on child mortality. RESULTS Children who lived in homes with networked distance>5 km experienced approximately 17% increased mortality risk (HR=1.17; 95% CI 1.02-1.38) compared to those who lived <5 km networked distance to the nearest health facility. Death of a mother (HR=5.87; 95% CI 4.11-8.40), death of preceding sibling (HR=1.9; 95% CI 1.37-2.65), and twin birth (HR=2.9; 95% CI 2.27-3.74) were the strongest independent predictors of child mortality. CONCLUSIONS Physical access to health facilities is a determinant of child mortality in rural Tanzania. Innovations to improve access to health facilities coupled with birth spacing and care at birth are needed to reduce child deaths in rural Tanzania.
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Affiliation(s)
- Daniel Kadobera
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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100
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The high burden of infant deaths in rural Burkina Faso: a prospective community-based cohort study. BMC Public Health 2012; 12:739. [PMID: 22947029 PMCID: PMC3489611 DOI: 10.1186/1471-2458-12-739] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 08/29/2012] [Indexed: 11/10/2022] Open
Abstract
Background Infant mortality rates (IMR) remain high in many sub-Saharan African countries, especially in rural settings where access to health services may be limited. Studies in such communities can provide relevant data on the burden of and risk factors for infant death. We measured IMR and explored risk factors for infant death in a cohort of children born in Banfora Health District, a rural area in South-West Burkina Faso. Methods A prospective community-based cohort study was nested within the PROMISE-EBF trial (NCT00397150) in 24 villages of the study area. Maternal and infant baseline characteristics were collected at recruitment and after birth, respectively. Home visits were conducted at weeks 3, 6, 12, 24 and 52 after birth. Descriptive statistics were calculated using robust standard errors to account for cluster sampling. Cox multivariable regression was used to investigate potential risk factors for infant death. Results Among the 866 live born children included in the study there were 98 infant deaths, yielding an IMR of 113 per 1000 live births (95% CI: 89–143). Over 75% of infant deaths had occurred by 6 months of age and the post neonatal infant mortality rate was 67 per 1000 live births (95% CI: 51–88). Infections (35%) and preterm births complications (23%) were the most common probable causes of death by 6 months. Multivariable analyses identified maternal history of child death, polygyny, twin births and poor anthropometric z-scores at week-3 as factors associated with increased risk of infant death. Conclusions We observed a very high IMR in a rural area of Burkina Faso, a country where 75% of the population lives in rural settings. Community-based health interventions targeting mothers and children at high risk are urgently needed to reduce the high burden of infant deaths in these areas.
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