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Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization

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ABSTRACT

Background: Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span.

Methods: We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization.

Results: Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001).

Conclusions: Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo.

Electronic supplementary material: The online version of this article (doi:10.1186/s12913-016-1709-7) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

Child Health Services Utilization: Adjusted mean and 95 % confidence interval for prevalence of childhood illness and receipt of care among respondents to the Konobo survey as compared to the rural subsection of DHS 2007 and DHS 2013
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Fig2: Child Health Services Utilization: Adjusted mean and 95 % confidence interval for prevalence of childhood illness and receipt of care among respondents to the Konobo survey as compared to the rural subsection of DHS 2007 and DHS 2013

Mentions: There was no significant difference in the prevalence of ARI in the 2007 DHS (10 %) as compared to the 2013 DHS (8 %, AOR 1.29, CI 0.97–1.71, P = 0.078). Prevalence of ARI symptoms in Konobo was significantly higher (22 %), (Konobo versus DHS 2013, AOR 2.32, CI 1.59–3.38, P < 0.001). Similar findings were noted in the prevalence of diarrhea (Fig. 2).Fig. 2


Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization
Child Health Services Utilization: Adjusted mean and 95 % confidence interval for prevalence of childhood illness and receipt of care among respondents to the Konobo survey as compared to the rural subsection of DHS 2007 and DHS 2013
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5015243&req=5

Fig2: Child Health Services Utilization: Adjusted mean and 95 % confidence interval for prevalence of childhood illness and receipt of care among respondents to the Konobo survey as compared to the rural subsection of DHS 2007 and DHS 2013
Mentions: There was no significant difference in the prevalence of ARI in the 2007 DHS (10 %) as compared to the 2013 DHS (8 %, AOR 1.29, CI 0.97–1.71, P = 0.078). Prevalence of ARI symptoms in Konobo was significantly higher (22 %), (Konobo versus DHS 2013, AOR 2.32, CI 1.59–3.38, P < 0.001). Similar findings were noted in the prevalence of diarrhea (Fig. 2).Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span.

Methods: We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization.

Results: Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P&thinsp;&lt;&thinsp;0.001) or any postnatal care (AOR 0.25, P &lt;0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9&nbsp;% vs. 52&nbsp;%, P&thinsp;&lt;&thinsp;0.001) or diarrhea (11&nbsp;% vs. 46&nbsp;%, P&thinsp;&lt;&thinsp;0.001).

Conclusions: Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo.

Electronic supplementary material: The online version of this article (doi:10.1186/s12913-016-1709-7) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus