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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

Pyramidal four-stage referral system of health-care delivery in Madagascar.
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pone-0038370-g003: Pyramidal four-stage referral system of health-care delivery in Madagascar.

Mentions: According to the Plan de Développement Secteur Santé 2007–2011, the health delivery system in Madagascar is composed of four types of health centers: basic health centers (Centre de Santé de Base: CSB) I and II; district hospitals (Centre Hospitalier de District: CHD) I and II; regional hospitals (Centre Hospitalier Regional: CHR); and university hospitals (Centres Hospitaliers Universitaires: CHU). Among these, only CSB I is not assigned a full-time medical doctor. These health facilities are composed of a four-step pyramidal referral system (Figure 3). The majority of these facilities is in imbalances in the distribution of medical staff [10] and concentrated in Antananarivo and other major cities. Indeed, around 28% of doctors serve 75% of the population living in the rural areas [10]. In these public health centers, the basic physical examination was provided without any charge. Also the Madagascar government introduced an equity funds system for achieving universal access to health care. The system funds the basic care or essential drugs to residents if they are certified as being poor by communities (fokontany and commune) [11]. Although these programs were provided by the government, Madagascar ranks the third lowest among the 44 African countries in term of hospital care availability [10].


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)

Pyramidal four-stage referral system of health-care delivery in Madagascar.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0038370-g003: Pyramidal four-stage referral system of health-care delivery in Madagascar.
Mentions: According to the Plan de Développement Secteur Santé 2007–2011, the health delivery system in Madagascar is composed of four types of health centers: basic health centers (Centre de Santé de Base: CSB) I and II; district hospitals (Centre Hospitalier de District: CHD) I and II; regional hospitals (Centre Hospitalier Regional: CHR); and university hospitals (Centres Hospitaliers Universitaires: CHU). Among these, only CSB I is not assigned a full-time medical doctor. These health facilities are composed of a four-step pyramidal referral system (Figure 3). The majority of these facilities is in imbalances in the distribution of medical staff [10] and concentrated in Antananarivo and other major cities. Indeed, around 28% of doctors serve 75% of the population living in the rural areas [10]. In these public health centers, the basic physical examination was provided without any charge. Also the Madagascar government introduced an equity funds system for achieving universal access to health care. The system funds the basic care or essential drugs to residents if they are certified as being poor by communities (fokontany and commune) [11]. Although these programs were provided by the government, Madagascar ranks the third lowest among the 44 African countries in term of hospital care availability [10].

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