The effect of distance to formal health facility on childhood mortality in rural Tanzania, 2005-2007
The effect of distance to formal health facility on childhood mortality in rural Tanzania, 2005-2007
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DOI：
10.3402/gha.v5i0.19099
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发表时间：
2012-01-01
影响因子：
2.6
通讯作者：
Waiswa, Peter
中科院分区：
文献类型：
--
作者：
Kadobera, Daniel;Sartorius, Benn;Waiswa, Peter
背景：为实现千年发展目标四（千年发展目标4），需要在基本儿童干预措施的覆盖范围和质量方面进行重大改进。距离卫生设施很远是已知的就医障碍之一。2005年至2007年间，我们调查了从家到正规医疗机构的网络距离和欧几里得距离对坦桑尼亚农村儿童死亡率的影响。方法：对2005年至2007年间来自Ifakara健康和人口监测系统的28,823名5岁以下儿童的队列数据进行二次分析。使用地理信息系统方法计算从家庭到最近的卫生设施的欧氏距离和网络距离。使用Cox比例风险回归模型来调查从家到最近的医疗机构的距离对儿童死亡率的影响。结果：与距离最近的医疗机构网络距离< 5公里的家庭相比，居住在网络距离为bb50公里的家庭的儿童死亡风险增加了约17% （HR = 1.17; 95% CI 1.02-1.38）。母亲死亡（HR = 5.87; 95% CI 4.11-8.40）、前一个兄弟姐妹死亡（HR = 1.9; 95% CI 1.37-2.65）和双胞胎出生（HR = 2.9; 95% CI 2.27-3.74）是儿童死亡率最强的独立预测因子。结论：在坦桑尼亚农村，获得卫生设施是儿童死亡率的一个决定因素。要减少坦桑尼亚农村地区的儿童死亡，就需要创新，改善获得保健设施的机会，同时考虑到生育间隔和出生时的护理。
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.