The effect of distance to formal health facility on chilhood mortality: case of Ifakara DSS in rural Tanzania

Abstract

Background: MDG 4 commits the international community to reducing mortality in children younger than 5 years by two-thirds by 2015.The biggest burden of child mortality lies in Saharan Africa. Objective: To investigate how distance from home to the nearest health facility is associated with infant and child (1-4 years) mortality in a typical rural setting of sub Saharan Africa. Methods: A secondary analysis of 28,823 under five children in Ifakara Health and Demographic surveillance system between 2005 and 2007 was carried out. Both Euclidean and networked distance from the household to the nearest health facility was estimated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on infant and child mortality. Results: Children who lived in homes with networked distance >5KM experienced about 18% increased mortality risk [HR=1.18;95%CI 1.02-1.38 p-value 0.05] compared to those who lived less than 5KM networked distance to the nearest health facility. Death of mother, death of preceding sibling and multiple births were the strongest independent predictors of child mortality. Malaria/AFI and pneumonia/ARI were the leading causes of death in children although there was no evidence to show association of cause specific mortality with networked distance in the study. vi Conclusions: Staying closer to the health facility improved the survival probability of the children. This effect was similar to that reported elsewhere in other studies which re-emphasize the usefulness of having fully functional health facilities closer to the populations that need them. The inconsistency of the Euclidean distance in the study further suggests that the networked distance is a better estimator of geographical accessibility and should be the preferred proxy distance measurement option in public health research. 1 Faculty of Health Sciences, University of the Witwatersrand; South Africa. 2 Ifakara Health & Demographic Surveillance System; Tanzania. 3 Iganga/Mayuge Health & Demographic Surveillance System; Uganda