effect of geographical access to health facilities on child mortality in rural ethiopia a community based cross sectional study地理获得卫生设施对儿童死亡率的影响在埃塞俄比亚农村社区为基础的横断面研究.pdfVIP

Effect of Geographical Access to Health Facilities on Child Mortality in Rural Ethiopia: A Community Based Cross Sectional Study 1 1 2 1 1 Yemisrach B. Okwaraji *, Simon Cousens , Yemane Berhane , Kim Mulholland , Karen Edmond 1 Faculty of Epidemiology and Population Health, London School of Hygiene Tropical Medicine, London, United Kingdom, 2 Addis Continental, Institute of Public Health, Addis Ababa, Ethiopia Abstract Background: There have been few studies that have examined associations between access to health care and child health outcomes in remote populations most in need of health services. This study assessed the effect of travel time and distance to health facilities on mortality in children under five years in a remote area of rural north-western Ethiopia. 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) was used to map all households and the only health centre in the district. The analysis was restricted to 2,206 rural children who were under the age of five years during the five years before the survey. Data were analysed using random effects Poisson regression. 90.4% (1,996/2,206) of children lived more than 1.5 hours walk from the health centre. Children who lived $1.5 hrs from the health centre had a two to three fold greater risk of death than children who lived ,1.5 hours from the health centre (children with travel time 1.5–,2.5 hrs adjusted relative risk [adjRR] 2.3[0.95–5.6], travel time 2.5– ,3.5 hrs adjRR 3.1[1.3–7.4] and travel time 3.5–,6.5 hrs adjRR 2.5[1.1–6.2]). Conclusion: Distance to