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Association between proximity to a health center and early childhood mortality in Madagascar.

Kashima S, Suzuki E, Okayasu T, Jean Louis R, Eboshida A, Subramanian SV - PLoS ONE (2012)

Bottom Line: The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status.Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset.The accessibility to health care in remote areas would be a key factor to achieve better infant health.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health and Health Policy, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan. saori_ksm@ybb.ne.jp

ABSTRACT

Objective: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance.

Methods: From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1), nested within 584 village locations (level 2), and in turn nested within 22 regions (level 3). We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia.

Results: Compared with those who lived >1.5-3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0-10.0 km away from a health center were 1.36 (95% CI: 0.92-2.01) and 1.42 (95% CI: 1.06-1.90), respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status.

Conclusions: Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve better infant health.

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Related in: MedlinePlus

A map of Madagascar indicating the survey points for the 2008–2009 Demographic and Health Survey (EDSMD-IV).DHS, Demographic and Health Survey; EDSMD, quatrième Enquête Démographique et de Santé réalisée à Madagascar.
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pone-0038370-g001: A map of Madagascar indicating the survey points for the 2008–2009 Demographic and Health Survey (EDSMD-IV).DHS, Demographic and Health Survey; EDSMD, quatrième Enquête Démographique et de Santé réalisée à Madagascar.

Mentions: The study was based on 48464 birth records from the 2008–2009 Demographic and Health Survey (quatrième Enquête Démographique et de Santé réalisée à Madagascar: EDSMD-IV), which is a nationally representative sample survey. The 2008–2009 EDSMD-IV fieldwork was carried out from November 2008 to mid-August 2009 in selected areas in 22 regions in Madagascar (Figure 1). The EDSMD-IV samples were selected using a stratified two-stage design. First, each of the 22 regions was divided into 45 strata designated as urban, rural, and the city of Antananarivo. Then, 600 clusters were identified with a probability proportional to the size of the 22 regions. In the second stage, 32 households were randomly selected from each of the 600 clusters [9]. Each household was then surveyed.


Association between proximity to a health center and early childhood mortality in Madagascar.

Kashima S, Suzuki E, Okayasu T, Jean Louis R, Eboshida A, Subramanian SV - PLoS ONE (2012)

A map of Madagascar indicating the survey points for the 2008–2009 Demographic and Health Survey (EDSMD-IV).DHS, Demographic and Health Survey; EDSMD, quatrième Enquête Démographique et de Santé réalisée à Madagascar.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3366931&req=5

pone-0038370-g001: A map of Madagascar indicating the survey points for the 2008–2009 Demographic and Health Survey (EDSMD-IV).DHS, Demographic and Health Survey; EDSMD, quatrième Enquête Démographique et de Santé réalisée à Madagascar.
Mentions: The study was based on 48464 birth records from the 2008–2009 Demographic and Health Survey (quatrième Enquête Démographique et de Santé réalisée à Madagascar: EDSMD-IV), which is a nationally representative sample survey. The 2008–2009 EDSMD-IV fieldwork was carried out from November 2008 to mid-August 2009 in selected areas in 22 regions in Madagascar (Figure 1). The EDSMD-IV samples were selected using a stratified two-stage design. First, each of the 22 regions was divided into 45 strata designated as urban, rural, and the city of Antananarivo. Then, 600 clusters were identified with a probability proportional to the size of the 22 regions. In the second stage, 32 households were randomly selected from each of the 600 clusters [9]. Each household was then surveyed.

Bottom Line: The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status.Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset.The accessibility to health care in remote areas would be a key factor to achieve better infant health.

View Article: PubMed Central - PubMed

Affiliation: Department of Public Health and Health Policy, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan. saori_ksm@ybb.ne.jp

ABSTRACT

Objective: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance.

Methods: From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1), nested within 584 village locations (level 2), and in turn nested within 22 regions (level 3). We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia.

Results: Compared with those who lived >1.5-3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0-10.0 km away from a health center were 1.36 (95% CI: 0.92-2.01) and 1.42 (95% CI: 1.06-1.90), respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status.

Conclusions: Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve better infant health.

Show MeSH
Related in: MedlinePlus