The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya
The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya
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DOI：
10.1111/j.1365-3156.2008.02193.x
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发表时间：
2009-01-01
影响因子：
3.3
通讯作者：
Lindblade, Kim A.
中科院分区：
文献类型：
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作者：
Feikin, Daniel R.;Nguyen, Ly Minh;Lindblade, Kim A.
为探讨距离对肯尼亚西部农村地区Asembo患病儿童就诊周边卫生设施利用率的影响，作为人口监测系统（DSS）的一部分，每年对Asembo 55 000人口的所有家庭进行三次人口普查，在Asembo的七个DSS诊所的所有门诊儿科就诊中收集数据，所有的家庭都是GIS映射的，并与孩子唯一的DSS识别号码相关联。在2003年5月1日至2004年4月30日期间，在10 973名5岁以下的儿童中，有2 432名儿童到3 501家诊所就诊，年龄较小的儿童和病情较重的儿童到更远的诊所就诊。中位移动距离因诊所而异。诊所就诊率在0.5公里至4公里的间隔内呈线性下降，之后趋于稳定。使用泊松回归，控制每个儿童最近的DSS诊所、社会经济地位和母亲教育，并考虑儿童的家庭聚集，居住地距离DSS诊所每增加1公里，诊所就诊率下降34%（95%CI，31-37%）与前一公里相比。实现肯尼亚农村儿童公平获得医疗保健需要创造性的策略来解决医疗保健利用中显着的距离衰减效应。
To explore the impact of distance on utilisation of peripheral health facilities for sick child visits in Asembo, rural western Kenya.As part of a demographic surveillance system (DSS), censuses of all households in the Asembo population of 55 000 are conducted three times a year, data are collected at all outpatient pediatric visits in seven DSS clinics in Asembo, and all households are GIS-mapped and linkable to a child's unique DSS identification number. Between May 1, 2003 and April 30, 2004, 3501 clinic visits were linked to 2432 children among 10 973 DSS-resident children < 5 years of age.Younger children and children with more severe illnesses travelled further for clinic visits. The median distance travelled varied by clinic. The rate of clinic visits decreased linearly at 0.5 km intervals up to 4 km, after which the rate stabilised. Using Poisson regression, controlling for the nearest DSS clinic for each child, socio-economic status and maternal education, and accounting for household clustering of children, for every 1 km increase in distance of residence from a DSS clinic, the rate of clinic visits decreased by 34% (95% CI, 31-37%) from the previous kilometer.Achieving equity in access to health care for children in rural Kenya will require creative strategies to address a significant distance-decay effect in health care utilisation.