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Oldenburg CE, Sié A, Ouattara M, Bountogo M, Boudo V, Kouanda I, Lebas E, Brogdon JM, Lin Y, Nyatigo F, Arnold BF, Lietman TM. Distance to primary care facilities and healthcare utilization for preschool children in rural northwestern Burkina Faso: results from a surveillance cohort. BMC Health Serv Res 2021; 21:212. [PMID: 33750364 PMCID: PMC7941928 DOI: 10.1186/s12913-021-06226-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 03/01/2021] [Indexed: 11/21/2022] Open
Abstract
Background Delays in care-seeking for childhood illness may lead to more severe outcomes. We evaluated whether community distance from a primary healthcare facility was associated with decreased healthcare utilization in a rural district of northwestern Burkina Faso. Methods We conducted passive surveillance of all government-run primary healthcare facilities in Nouna District, Burkina Faso from March 1 through May 31, 2020. All healthcare visits for children under 5 years of age were recorded on a standardized form for sick children. We recorded the age, sex, and community of residence of the child as well as any diagnoses and treatments administered. We calculated healthcare utilization per 100 child-months by linking the aggregate number of visits at the community level to the community’s population of children under 5 months per a census that was conducted from August 2019 through February 2020. We calculated the distance between each community and its corresponding healthcare facility and assessed the relationship between distance and the rate of healthcare utilization. Results In 226 study communities, 12,676 primary healthcare visits were recorded over the three-month period. The median distance between the community and primary healthcare facility was 5.0 km (IQR 2.6 to 6.9 km), and median number of healthcare visits per 100 child-months at the community level was 6.7 (IQR 3.7 to 12.3). The rate of primary healthcare visits declined with increasing distance from clinic (Spearman’s rho − 0.42, 95% CI − 0.54 to − 0.31, P < 0.0001). This relationship was similar for cause-specific clinic visits (including pneumonia, malaria, and diarrhea) and for antibiotic prescriptions. Conclusions We documented a distance decay effect between community distance from a primary healthcare facility and the rate of healthcare visits for children under 5. Decreasing distance-related barriers, for example by increasing the number of facilities or targeting outreach to more distant communities, may improve healthcare utilization for young children in similar settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06226-5.
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Affiliation(s)
- Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA. .,Department of Ophthalmology, University of California, San Francisco, USA. .,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA.
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Valentin Boudo
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Elodie Lebas
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA
| | - Jessica M Brogdon
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA
| | - Ying Lin
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA
| | - Fanice Nyatigo
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA
| | - Benjamin F Arnold
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA.,Department of Ophthalmology, University of California, San Francisco, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, 513 Parnassus Ave, Box 0412, San Francisco, CA, 94143, USA.,Department of Ophthalmology, University of California, San Francisco, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, USA
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Shibre G. Social inequality in infant mortality in Angola: Evidence from a population based study. PLoS One 2020; 15:e0241049. [PMID: 33091077 PMCID: PMC7580929 DOI: 10.1371/journal.pone.0241049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 10/07/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Within country inequality in infant mortality poses a big challenge for countries moving towards the internationally agreed upon targets on child mortality by 2030. There is a lack of high-quality evidence on infant mortality measured through different dimensions of social inequality in Angola. Thus, this paper was carried out to address the knowledge gap by conducting in-depth examination of infant mortality rate (IMR) inequality among population subgroups to provide more nuanced evidence to help end IMR disparity in the country. METHODS The World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) was used to analyze IMR inequality. HEAT is a software application that facilitates examination of disparities in reproductive, maternal, neonatal and child health indicators using the WHO Health Equity Monitor (HEM) database. Inequality of IMR was analyzed through disaggregation by five equity stratifiers: education, wealth, gender, subnational region and residence. These were analyzed through three inequality measures: Population Attributable Risk, Ratio and Slope Index of Inequality. A 95% confidence Interval (CI) was built around point estimates to determine statistical significance. RESULTS A notable disadvantage was found for children born to poor (Population Attributable Risk (PAR): -27.0; -28.4, -26.0) and uneducated (PAR: -17.0; -17.9, -16.0), women who live in rural areas (PAR: -7.3;-7.8, -6.7) and those residing in certain regions of the country (PAR: -43.0; 45.3, -4). Male infants had a higher risk of death than female infants (PAR: -6.8;-7.5, -6.2). The subnational regional variation of IMR had been the most evident when compared with the disparities in the other equity stratifers. CONCLUSIONS Policymakers and planners need to address the disproportionately higher clustering of IMR among infants born to disadvantaged subpopulations through interventions that benefit such subgroups.
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Affiliation(s)
- Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
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Mackinnon E, Ayah R, Taylor R, Owor M, Ssempebwa J, Olago LD, Kubalako R, Dia AT, Gaye C, C Campos L, Fottrell E. 21st century research in urban WASH and health in sub-Saharan Africa: methods and outcomes in transition. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2019; 29:457-478. [PMID: 30545246 DOI: 10.1080/09603123.2018.1550193] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/15/2018] [Indexed: 06/09/2023]
Abstract
Tackling global inequalities in access to Water, Sanitation and Hygiene (WASH) remains an urgent issue - 58% of annual diarrhoeal deaths are caused by inadequate WASH provision. A global context of increasing urbanisation, changing demographics and health transitions demands an understanding and impact of WASH on a broad set of health outcomes. We examine the literature, in terms of health outcomes, considering WASH access and interventions in urban sub-Saharan Africa from 2000 to 2017. Our review of studies which evaluate the effectiveness of specific WASH interventions, reveals an emphasis of WASH research on acute communicable diseases, particularly diarrhoeal diseases. In contrast, chronic communicable and non-communicable health outcomes were notable gaps in the literature as well as a lack of focus on cross-cutting issues, such as ageing, well-being and gender equality. We recommend a broader focus of WASH research and interventions in urban Africa to better reflect the demographic and health transitions happening. Abbreviations: CBA: Controlled Before and After; GSD: Government Service Delivery; IWDSSD: International Drinking-Water, Supply and Sanitation Decade (IDWSSD); KAP: Knowledge, Attitudes and Practices; IBD: Irritable Bowel Diseases; MDG: Millennium Development Goals; NTD: Neglected Tropical Diseases; PSSD: Private Sector Service Delivery; SDG: Sustainable Development Goals; SSA: Sub Saharan Africa; SODIS: Solar Disinfection System; STH: Soil Transmitted Helminths; RCT: Randomised Control Trial; WASH: Water Sanitation and Hygiene; WHO: World Health Organization.
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Affiliation(s)
- Eve Mackinnon
- a Civil, Environmental and Geomatic Engineering , University College London , London , United Kingdom of Great Britain and Northern Ireland
| | - Richard Ayah
- b Faculty of Science Engineering and Health , Daystar University Nairobi , Nairobi , Kenya
| | - Richard Taylor
- c Department of Geography , University College London , London , United Kingdom of Great Britain and Northern Ireland
| | - Michael Owor
- d Department of Geology and Petroleum Studies , Makerere University , Kampala , Uganda
| | - John Ssempebwa
- e College of Agricultural and Environmental Sciences , Makerere University , Kampala , Uganda
| | - L Daniel Olago
- b Faculty of Science Engineering and Health , Daystar University Nairobi , Nairobi , Kenya
| | - Robinah Kubalako
- e College of Agricultural and Environmental Sciences , Makerere University , Kampala , Uganda
| | - Anta Tal Dia
- f Department of Geology, FST , Universite Cheikh Anta Diop , Dakar , Senegal
| | - Cheikh Gaye
- f Department of Geology, FST , Universite Cheikh Anta Diop , Dakar , Senegal
| | - Luiza C Campos
- a Civil, Environmental and Geomatic Engineering , University College London , London , United Kingdom of Great Britain and Northern Ireland
| | - Edward Fottrell
- g University College, London Institute of Global Health , London , United Kingdom of Great Britain and Northern Ireland
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Frings M, Lakes T, Müller D, Khan MMH, Epprecht M, Kipruto S, Galea S, Gruebner O. Modeling and mapping the burden of disease in Kenya. Sci Rep 2018; 8:9826. [PMID: 29959405 PMCID: PMC6026135 DOI: 10.1038/s41598-018-28266-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 06/12/2018] [Indexed: 11/09/2022] Open
Abstract
Precision public health approaches are crucial for targeting health policies to regions most affected by disease. We present the first sub-national and spatially explicit burden of disease study in Africa. We used a cross-sectional study design and assessed data from the Kenya population and housing census of 2009 for calculating YLLs (years of life lost) due to premature mortality at the division level (N = 612). We conducted spatial autocorrelation analysis to identify spatial clusters of YLLs and applied boosted regression trees to find statistical associations between locational risk factors and YLLs. We found statistically significant spatial clusters of high numbers of YLLs at the division level in western, northwestern, and northeastern areas of Kenya. Ethnicity and household crowding were the most important and significant risk factors for YLL. Further positive and significantly associated variables were malaria endemicity, northern geographic location, and higher YLL in neighboring divisions. In contrast, higher rates of married people and more precipitation in a division were significantly associated with less YLL. We provide an evidence base and a transferable approach that can guide health policy and intervention in sub-national regions afflicted by disease burden in Kenya and other areas of comparable settings.
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Affiliation(s)
- Michael Frings
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany
| | - Tobia Lakes
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany
| | - Daniel Müller
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany.,Leibniz Institute of Agricultural Development in Transition Economies (IAMO), Halle (Saale), Germany
| | - M M H Khan
- University of Bielefeld, School of Public Health, Department of Public Health Medicine, Bielefeld, Germany
| | - Michael Epprecht
- University of Bern, Center for Development and Environment (CDE), Bern, Switzerland
| | | | - Sandro Galea
- Boston University, Department of Epidemiology, Boston, MA, USA
| | - Oliver Gruebner
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany. .,University of Zürich, Epidemiology, Biostatistics, and Prevention Institute (EBPI), Zürich, Switzerland.
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Gruebner O, Khan M, Burkart K, Lautenbach S, Lakes T, Krämer A, Subramanian SV, Galea S. Spatial variations and determinants of infant and under-five mortality in Bangladesh. Health Place 2017; 47:156-164. [PMID: 28888890 DOI: 10.1016/j.healthplace.2017.08.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 06/19/2017] [Accepted: 08/29/2017] [Indexed: 11/19/2022]
Abstract
Reducing child mortality is a Sustainable Development Goal yet to be achieved by many low-income countries. We applied a subnational and spatial approach based on publicly available datasets and identified permanent insolvency, urbanicity, and malaria endemicity as factors associated with child mortality. We further detected spatial clusters in the east of Bangladesh and noted Sylhet and Jamalpur as those districts that need immediate attention to reduce child mortality. Our approach is transferable to other regions in comparable settings worldwide and may guide future studies to identify subnational regions in need for public health attention. Our study adds to our understanding where we may intervene to more effectively improve health, particularly among disadvantaged populations.
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Affiliation(s)
- Oliver Gruebner
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany; University of Zurich, Epidemiology, Biostatistics, and Prevention Institute, Zurich, Switzerland.
| | - Mmh Khan
- King Faisal University, College of Applied Medical Sciences, Department of Public Health, Saudi Arabia; University of Bielefeld, School of Public Health, Department of Public Health Medicine, Bielefeld, Germany
| | - Katrin Burkart
- Columbia University, Mailman School of Public Health, Department of Environmental Health Sciences, New York City, NY, USA
| | - Sven Lautenbach
- University of Bonn, Institute of Geodesy and Geoinformation (IGG), Bonn, Germany
| | - Tobia Lakes
- Humboldt-Universität zu Berlin, Geography Department, Berlin, Germany
| | - Alexander Krämer
- University of Bielefeld, School of Public Health, Department of Public Health Medicine, Bielefeld, Germany
| | - S V Subramanian
- Harvard T.H. Chan School of Public Health, Department of Social and Behavioral Sciences, Boston, MA, USA
| | - Sandro Galea
- Boston University, School of Public Health, Boston, MA, USA
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