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Impacto de la distancia desde la residencia al centro sanitario periférico sobre la utilización de servicios pediátricos en una zona rural del oeste de Kenia
Author(s) -
Feikin Daniel R.,
Nguyen Ly Minh,
Adazu Kubaje,
Ombok Maurice,
Audi Allan,
Slutsker Laurence,
Lindblade Kim A.
Publication year - 2009
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/j.1365-3156.2008.02193.x
Subject(s) - residence , poisson regression , medicine , health facility , kilometer , population , developing country , socioeconomic status , demography , rural area , health care , outpatient clinic , environmental health , pediatrics , geography , family medicine , health services , economic growth , physics , pathology , astronomy , sociology , economics
Summary Objective To explore the impact of distance on utilisation of peripheral health facilities for sick child visits in Asembo, rural western Kenya. Methods As part of a demographic surveillance system (DSS), censuses of all households in the Asembo population of 55 000 are conducted three times a year, data are collected at all outpatient pediatric visits in seven DSS clinics in Asembo, and all households are GIS‐mapped and linkable to a child’s unique DSS identification number. Between May 1, 2003 and April 30, 2004, 3501 clinic visits were linked to 2432 children among 10 973 DSS‐resident children < 5 years of age. Results Younger children and children with more severe illnesses travelled further for clinic visits. The median distance travelled varied by clinic. The rate of clinic visits decreased linearly at 0.5 km intervals up to 4 km, after which the rate stabilised. Using Poisson regression, controlling for the nearest DSS clinic for each child, socio‐economic status and maternal education, and accounting for household clustering of children, for every 1 km increase in distance of residence from a DSS clinic, the rate of clinic visits decreased by 34% (95% CI, 31–37%) from the previous kilometer. Conclusion Achieving equity in access to health care for children in rural Kenya will require creative strategies to address a significant distance‐decay effect in health care utilisation.