Effect of Geographical Access to Health Facilities on Child Mortality in Rural Ethiopia A Community Based Cross Sectional Study 英文参考文献.docVIP

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Effect of Geographical Access to Health Facilities on Child Mortality in Rural Ethiopia A Community Based Cross Sectional Study 英文参考文献.doc

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Effect of Geographical Access to Health Facilities on Child Mortality in Rural Ethiopia A Community Based Cross Sectional Study 英文参考文献

EffectofGeographicalAccesstoHealthFacilitieson ChildMortalityinRuralEthiopia:ACommunityBased CrossSectionalStudy YemisrachB.Okwaraji1*,SimonCousens1,YemaneBerhane2,KimMulholland1,KarenEdmond1 1Faculty of Epidemiology and Population Health, London School of Hygiene Tropical Medicine, London, United Kingdom, 2Addis Continental, Institute of Public Health,AddisAbaba,Ethiopia Abstract Background:Therehavebeenfewstudiesthathaveexaminedassociationsbetweenaccesstohealthcareandchildhealth outcomesinremotepopulationsmostinneedofhealthservices.Thisstudyassessedtheeffectoftraveltimeanddistance tohealthfacilitiesonmortalityinchildrenunderfiveyearsinaremoteareaofruralnorth-westernEthiopia. Methods and Findings: This study involved a randomly selected cross sectional survey of 2,058 households. Data were collected during home visits to all resident women of reproductive age (15–49 years). A geographic information system (GIS)wasusedtomapallhouseholdsandtheonlyhealthcentreinthedistrict.Theanalysiswasrestrictedto2,206rural childrenwhowereundertheageoffiveyearsduringthefiveyearsbeforethesurvey.Datawereanalysedusingrandom effectsPoissonregression.90.4%(1,996/2,206)ofchildrenlivedmorethan1.5hourswalkfromthehealthcentre.Children wholived$1.5hrsfromthehealthcentrehadatwotothreefoldgreaterriskofdeaththanchildrenwholived,1.5hours fromthehealthcentre(childrenwithtraveltime1.5–,2.5hrsadjustedrelativerisk[adjRR]2.3[0.95–5.6],traveltime2.5– ,3.5hrsadjRR3.1[1.3–7.4]andtraveltime3.5–,6.5hrsadjRR2.5[1.1–6.2]). Conclusion: Distance to ahealth centre hada marked influence on under five mortality in a poor, rural, remotearea of Ethiopia.Thisstudyprovidesimportantinformationforpolicymakersonthelikelyimpactofnewhealthcentresandtheir mosteffectivelocationinremoteareas. Citation:OkwarajiYB,CousensS,BerhaneY,MulhollandK,EdmondK(2012)EffectofGeographicalAccesstoHealthFacilitiesonChildMortalityinRuralEthiopia: ACommunityBasedCrossSectionalStudy.PLoSONE7(3):e33564.doi:10.1371/journal.pone.0033564 Editor