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Facility distance and child mortality: a multi-country study of health facility access, service utilization, and child health outcomes
Authors: Karra M, Fink G, and Canning D
Source: International Journal of Epidemiology, 46(3): 817-826; DOI: 10.1093/ije/dyw062
Topic(s): Antenatal care
Childhood mortality
Delivery care
Health care utilization
Institutional births
Maternal health
Country: More than one region
  Multiple Regions
Published: JUN 2017
Abstract: Background: Access to health facilities remains limited in many resource-poor settings, and women and their children often have to travel far to seek care. However, data on distance are scarce, and it is unclear whether distance is associated with worse child health outcomes. We estimate the relationships between distance to facility, service utilization and child mortality in low- and middle-income countries. Methods: Population-representative data are pooled from 29 demographic and health surveys across 21 low- and middle-income countries. Multivariable logistic models and meta-analysis regressions are used to estimate associations between facility distance, child mortality, and health care utilization in the pooled sample as well as for each survey. Results: Compared with children who live within 1?km of a facility, children living within 2?km, 3?km, and 5?km of a facility have a 7.7% [95% confidence interval (CI): 0.927 - 1.251], 16.3% (95% CI: 1.020 - 1.327) and 25% (95% CI: 1.087 - 1.439) higher odds of neonatal mortality, respectively; children living farther than 10?km have a 26.6% (95% CI: 1.108 - 1.445) higher odds of neonatal mortality. Women living farther than 10?km from a facility have a 55.3% lower odds of in-facility delivery compared with women who live within 1?km [odds ratio (OR): 0.447; 95% CI: 0.394 - 0.508]. Conclusions: Even relatively small distances from health facilities are associated with substantial mortality penalties for children. Policies that reduce travel distances and travel times are likely to increase utilization of health services and reduce neonatal mortality. © The Author 2016; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association KEYWORDS: Distance; antenatal care; child mortality; facility delivery; service availability