scholarly journals The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980–1998

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
John P. Quattrochi ◽  
Kenneth Hill ◽  
Joshua A. Salomon ◽  
Marcia C. Castro
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health Facility ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Place Of Delivery ◽  
Skilled Assistance ◽  
Linear Probability ◽  
Antenatal Visits ◽  
Delivery Place

Abstract Background Despite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates. Methods We combined retrospective reports on 18,714 births between 1980 and 1998 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. We estimated associations between distance to nearest health facility and (i) under-5 mortality, using Cox proportional hazards models, and (ii) maternal health care utilization (antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery), using linear probability models. We also estimated the causal effect of reducing the distance to nearest facility on those outcomes, using a two-way fixed effects approach. Findings We found that greater distance was associated with higher mortality (hazard ratio 1.007 for one additional kilometer [95%CI 1.001 to 1.014]) and lower health care utilization (for one additional kilometer: 1.2 percentage point (pp) increase in homebirth [95%CI 0.8 to 1.5]; 0.8 pp. decrease in at least three antenatal visits [95% CI − 1.4 to − 0.2]; 1.2 pp. decrease in skilled assistance during delivery [95%CI − 1.6 to − 0.8]). However, we found no effects of a decrease in distance to the nearest health facility on the hazard of death before age 5 years, nor on antenatal visits prior to delivery, place of delivery, or receiving skilled assistance during delivery. We also found that reductions in distance decrease the probability that a woman receives a check-up following delivery (2.4 pp. decrease for a 1 km decrease [95%CI 0.004 to 0.044]). Conclusion Reducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure. Importantly, the effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors.

scholarly journals The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-1998

2020 ◽  
Author(s):  
John Paul Quattrochi ◽  
Kenneth Hill ◽  
Joshua A Salomon ◽  
Marcia C Castro
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health Facility ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Place Of Delivery ◽  
Skilled Assistance ◽  
Linear Probability ◽  
Antenatal Visits ◽  
Delivery Place

Abstract Background: Despite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates.Methods: We combined retrospective reports on 18,714 births between 1980 and 1998 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. We estimated associations between distance to nearest health facility and (i) under-5 mortality, using Cox proportional hazards models, and (ii) maternal health care utilization (antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery), using linear probability models. We also estimated the causal effect of reducing the distance to nearest facility on those outcomes, using a two-way fixed effects approach.Findings: We found that greater distance was associated with higher mortality (hazard ratio 1.007 for one additional kilometer [95%CI 1.001 to 1.014]) and lower health care utilization (for one additional kilometer: 1.2 percentage point (pp) increase in homebirth [95%CI 0.8 to 1.5]; 0.8pp decrease in at least three antenatal visits [95% CI -1.4 to -0.2]; 1.2pp decrease in skilled assistance during delivery [95%CI -1.6 to -0.8]). However, we found no effects of a decrease in distance to the nearest health facility on the hazard of death before age five years, nor on antenatal visits prior to delivery, place of delivery, or receiving skilled assistance during delivery. We also found that reductions in distance decrease the probability that a woman receives a check-up following delivery (2.4pp decrease for a one kilometer decrease [95%CI 0.004 to 0.044]).Conclusion: Reducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure. Importantly, the effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors.

scholarly journals The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-1998

2020 ◽  
Author(s):  
John Paul Quattrochi ◽  
Kenneth Hill ◽  
Joshua A Salomon ◽  
Marcia C Castro
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health Facility ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Place Of Delivery ◽  
Skilled Assistance ◽  
Linear Probability ◽  
Antenatal Visits ◽  
Delivery Place

Abstract BackgroundDespite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates.MethodsWe combined retrospective reports on 18,714 births between 1980 and 1998 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. We estimated associations between distance to nearest health facility and (i) under-5 mortality, using Cox proportional hazards models, and (ii) maternal health care utilization (antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery), using linear probability models. We also estimated the causal effect of reducing the distance to nearest facility on those outcomes, using a two-way fixed effects approach.FindingsWe found that greater distance was associated with higher mortality (hazard ratio 1.007 for one additional kilometer [95%CI 1.001 to 1.014]) and lower health care utilization (for one additional kilometer: 1.2 percentage point (pp) increase in homebirth [95%CI 0.8 to 1.5]; 0.8pp decrease in at least three antenatal visits [95% CI -1.4 to -0.2]; 1.2pp decrease in skilled assistance during delivery [95%CI -1.6 to -0.8]). However, we found no effects of a decrease in distance to the nearest health facility on the hazard of death before age five years, nor on antenatal visits prior to delivery, place of delivery, or receiving skilled assistance during delivery. We also found that reductions in distance decrease the probability that a woman receives a check-up following delivery (2.4pp decrease for a one kilometer decrease [95%CI 0.004 to 0.044]).ConclusionReducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure. Importantly, the effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors.

scholarly journals The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-1998

2020 ◽  
Author(s):  
John Paul Quattrochi ◽  
Kenneth Hill ◽  
Joshua A Salomon ◽  
Marcia C Castro
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health Facility ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Place Of Delivery ◽  
Skilled Assistance ◽  
Linear Probability ◽  
Antenatal Visits ◽  
Delivery Place

Abstract Background: Despite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates. Methods: We combined retrospective reports on 18,714 births between 1980 and 1998 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. We estimated associations between distance to nearest health facility and (i) under-5 mortality, using Cox proportional hazards models, and (ii) maternal health care utilization (antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery), using linear probability models. We also estimated the causal effect of reducing the distance to nearest facility on those outcomes, using a two-way fixed effects approach. Findings: We found that greater distance was associated with higher mortality (hazard ratio 1.007 for one additional kilometer [95%CI 1.001 to 1.014]) and lower health care utilization (for one additional kilometer: 1.2 percentage point (pp) increase in homebirth [95%CI 0.8 to 1.5]; 0.8pp decrease in at least three antenatal visits [95% CI -1.4 to -0.2]; 1.2pp decrease in skilled assistance during delivery [95%CI -1.6 to -0.8]). However, we found no effects of a decrease in distance to the nearest health facility on the hazard of death before age five years, nor on antenatal visits prior to delivery, place of delivery, or receiving skilled assistance during delivery. We also found that reductions in distance decrease the probability that a woman receives a check-up following delivery (2.4pp decrease for a one kilometer decrease [95%CI 0.004 to 0.044]). Conclusion: Reducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure. Importantly, the effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors.

scholarly journals The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-2000

2020 ◽  
Author(s):  
John Paul Quattrochi ◽  
Kenneth Hill ◽  
Joshua A Salomon ◽  
Marcia C Castro
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Facility ◽  
Rural Areas ◽  
Access To Health Care ◽  
Cox Proportional Hazards ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Probability Models ◽  
Linear Probability

Abstract Background: Despite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates. Methods: We combined retrospective reports on 22,088 births between 1980 and 2000 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. Using a difference-in-differences approach with Cox proportional hazards models, we estimated the effect of a reduction in distance to nearest facility, conditional on initial distance, on under-5 mortality. Using a difference-in-difference approach with linear probability models, we estimated the effect of a reduction in distance to nearest facility on number of antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery.Findings: We found no effects of a decrease in distance to the nearest health facility on the hazard of death before age five years. We also found no effect of reduced distance to nearest facility on utilization of maternal health services. The effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors.Conclusion: Reducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure.

scholarly journals The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-2000

2020 ◽  
Author(s):  
John Paul Quattrochi ◽  
Kenneth Hill ◽  
Joshua A Salomon ◽  
Marcia C Castro
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Facility ◽  
Rural Areas ◽  
Access To Health Care ◽  
Cox Proportional Hazards ◽  
Health Care Facilities ◽  
Care Utilization ◽  
Probability Models ◽  
Linear Probability

Abstract Background: Despite important progress, the burden of under-5 mortality remains unacceptably high, with an estimated 5.3 million deaths in 2018. Lack of access to health care is a major risk factor for under-5 mortality, and distance to health care facilities has been shown to be associated with less access to care in multiple contexts, but few such studies have used a counterfactual approach to produce causal estimates. Methods: We combined retrospective reports on 22,088 births between 1980 and 2000 from the 2000 Malawi Demographic and Health Survey with a 1998 health facility census that includes the date of construction for each facility, including 335 maternity or maternity/dispensary facilities built in rural areas between 1980 and 1998. Using a difference-in-differences approach with Cox proportional hazards models, we estimated the effect of a reduction in distance to nearest facility, conditional on initial distance, on under-5 mortality. Using a difference-in-difference approach with linear probability models, we estimated the effect of a reduction in distance to nearest facility on number of antenatal visits prior to delivery, place of delivery, receiving skilled assistance during delivery, and receiving a check-up following delivery. Findings: We found no effects of a decrease in distance to the nearest health facility on the hazard of death before age five years. We also found no effect of reduced distance to nearest facility on utilization of maternal health services. The effects estimated here likely depend on the quality of health care, the availability of transportation, the demand for health services, and the underlying causes of mortality, among other factors. Conclusion: Reducing under-5 mortality and increasing utilization of care in rural Malawi and similar settings may require more than the construction of new health infrastructure.

scholarly journals Primary Headache Disorders at a Tertiary Health Facility in Lagos, Nigeria: Prevalence and Consultation Patterns

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Olajumoke Oshinaike ◽  
Oluwadamilola Ojo ◽  
Njideka Okubadejo ◽  
Olaitan Ojelabi ◽  
Akinola Dada
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Health Facility ◽  
Primary Headache ◽  
Tension Type Headache ◽  
University Teaching ◽  
Care Utilization ◽  
Primary Headaches ◽  
Primary Headache Disorders ◽  
Type Headache

Background. Primary headaches are underdiagnosed and undertreated, with a significant impact on social activities and work.Aim.To determine the last-year prevalence and health care utilization pattern of primary headaches at a tertiary centre.Methods.A cross-sectional study was carried out amongst staff of the Lagos State University Teaching Hospital in Lagos, Nigeria. 402 staff members were selected by simple random sampling and administered a detailed structured headache assessment questionnaire. Migraine and tension-type headache were diagnosed according to the criteria of the International Headache Society (2004).Results.The participants comprised 168 males and 234 females. The mean age was36.9±7.9years. The overall headache prevalence was 39.3% with female predominance (P<0.0001). Tension-type headache was the most prevalent at 72.8% and migraine at 18.9%. Unclassifiable headache constituted 8.2%. Migraine headache showed female preponderance (P=0.000). 80.4% of participants did not seek medical consultation compared with 19.6% who did (P=0.000). Of the latter, 83.9% consulted the general practitioner (GP), whilst 16.1% consulted the neurologist.Conclusions.Primary headache prevalence is high in our population. It is not recognised as that requiring care by most of the staff of this tertiary health facility; thus education is required to increase health care utilization.

scholarly journals Determinants of Maternal Health Care Utilization in the Era of Free Maternity Services in Busia County, Kenya

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
B. Wafula ◽  
J. Arudo ◽  
M. Kipmerewo
Keyword(s):  
Health Care ◽  
Maternal Health ◽  
Health Care Utilization ◽  
Health Facility ◽  
Health Care Services ◽  
Maternal Health Care ◽  
Care Utilization ◽  
Maternal Health Care Utilization ◽  
Care Services ◽  
Maternal Health Care Services

Purpose. The main objective was to establish determinants of maternal health care utilization and specifically to assess the trends of maternal health care utilization and determine the predictors of maternal health care service utilization in the era of free maternity policy in Busia County. Methodology. It was a cross-sectional study design. The study was conducted between February and April 2019. The research targeted mothers within childbearing age of 15-49 years and a sample size of 634 mothers was used. Quantitative data were analyzed using SPSS version 22.0. Descriptive statistics was used to describe results on socio-demographic characteristics while inferential statistics employed bivariate and multivariate logistic regressions to investigate determinants of maternal health care utilization. Odds ratio was used to test the strength of association, and a p-value of ≤ 0.05 considered as statistically significant.  Results. In 2010, FANC increased by 5.6% from 2010 (pre-free maternity period) to 2017 (post-free maternity era). There was also an increase of 2.2% cases of health facility deliveries during pre-free maternity period (2010) and post-free maternity period (2017). Eleven predictors of maternal health care utilization were identified. Among them were respondent being a farmer (OR = 2.6; 95% CI: 1.4-4.8; p = 0.002), the status of the infrastructure of the nearest health facility maternity being good (OR = 3.2; 95% CI: 1.1-9.6; p = 0.03), fare for the public vehicle being USD 0.2 (OR = 3.4; 95% CI: 1.6-7.1; p = 0.001), all maternal health services being available in the nearest health facility (OR = 3.1; 95% CI: 1.8-5.4; p<0.0001), difficulty to attend MCH services due to non-suitability of working days (OR = 2.7; 95% CI: 1.5-4.7; p=0.0008), there being some services that clients pay for (OR = 3.3; 95% CI: 1.5-7.4; p=0.004), services being provided by nurses (midwives) (OR = 2.3; 95% CI: 1.0-4.9; p=0.04) , baby checkup being done within 24 hours by nurses (OR = 18.8; 95% CI: 8.0-44.0; p<0.0001. In conclusion, free maternity care program has led to increased utilization of facility ANC visits and deliveries in the study area. Barriers related to utilization of maternal health care services included unreliable transport especially at night, limited infrastructure and low socio-economic status of the women in the study area. National and county governments need to put in place strategies which will help them to jointly assess, map and plan investments to improve utilization of maternal health care services through prioritizing investments in human resource, infrastructure and commodities based on the anticipated demand for such services. A unique contribution to theory, practice, and policy: The study findings identified key factors that are unique to the mothers in Busia County on predisposing factors, enabling factors and the need characteristics that determine utilization of maternal health care in the era of Free Maternity services in the study area. These results contribute to both maternal health care utilization and policy change that could directly meet the social setting, geographical location and cultural needs of the people of Busia County.

scholarly journals Big Problem or Not a Big Problem: Problems to Health Care Utilization by Residence in The Gambia Among Women of Reproductive Age. A Cross Sectional Study

2021 ◽  
Author(s):  
Ebrima Barrow ◽  
Alieu Sowe
Keyword(s):  
Social Support ◽  
Health Care ◽  
Health Care Utilization ◽  
Health Facility ◽  
Statistical Significance ◽  
The Gambia ◽  
Reproductive Age ◽  
Care Utilization ◽  
Cultural Norms ◽  
Women Of Reproductive Age

Abstract Background: Ability to utilise healthcare services is desire for everyone in need. Unfortunately, challenges to health care utilization persist and they do so inequitably amongst social groups. This study aimed to examine problems to health care utilization and residential area equity in utilization among women of reproductive age in The Gambia. Methods: Data from The Gambia 2019-20 Demographic and Health Survey comprising of 11,865 women 15 – 49 years of age was used. A systematic selection method of equal probability was employed for the data collection interviews. Visiting any health facility in the last 12 months is the outcome. Problems to health care utilization was assessed using four primary factors of interest: permission to go, money needed for treatment, distance to health facility and not wanting to go alone as independent variables. Descriptive and logistic regression analysis were used to assess the frequency distribution and the association of the four factors and health care utilization by residence. The point estimates were reported in odds (OR), 95% confidence interval (CI) and p value <0.05 signified statistical significance.Results: Most women in rural (79%) and urban (83%) residential areas utilized health care services in the last 12 months. Women in urban areas who had a big problem getting permission to go and a big problem not wanting to go alone had lower odds of health care utilization compared to women who did not have a big problem getting permission to go and not wanting to go alone for health care. Women resident in rural areas who reported distance to health facility as a big problem had higher odds of health care utilization compared to women who did not have big problem concerning distance to health facility. Conclusions: Permission to go and not wanting to go alone appear to be associated with cultural norms and inadequate social support for women utilizing health care in urban residence. Policy makers should address harmful cultural norms and inadequate social support for women during health care visits to improve equity in health care utilization towards achieving universal health coverage.

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