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Access to health care and mortality of children under 5 years of age in the Gambia: a case–control study. Rutherford ME et al Bull of the World Health Organ 2009;87: 216-224. Learning Objective Child Health. Rationale & Introduction.

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slide1

Access to health care and mortality of children under 5 years of age in the Gambia: a case–control study

Rutherford ME et al

Bull of the World Health Organ 2009;87: 216-224

slide2

Learning Objective

  • Child Health
slide3

Rationale & Introduction

  • Approx. 98% of under 5 years death occurs in developing countries
  • Under 5 years child Mortality rate (Per 1000 live births)
    • Sub -Saharan Africa - 148
    • Developed countries - 6
    • South Asia -78
  • Poor access to health care may be a key determinant of under 5 years mortality
  • Association with traditional measures of accessibility (like distance from the household to a health facility, availability of transportation and health-care costs) were inconclusive
  • So, a need to consider additional measures of accessibility ( like social and financial barriers)
slide4

Objective

  • To assess whether traditional measures of access to health care (distance and travel time to a facility) and non-traditional measures (social and financial support indicators) are associated with mortality among children under 5 years of age in the Gambia
slide5

Methodology

  • Study Design: case–control study
  • Study Setting:Farafenni Demographic Surveillance System (FDSS), on the North Bank of the River Gambia
  • Study Duration: May 2006 – Oct 2006
  • Case: ( n=140)
    • Children under 5 years of age under coverage by the FDSS who had died between 31 December 2003 and 30 April 2006
  • Controls: (n=700)
    • Children under 5 years of age who were registered in the FDSS and who were alive at the time their respective cases died
    • 5 controls per case selected
  • Exclusion criteria:
    • primary caregiver could not be located or had since died or if cause of death of cases was unrelated to access to health care
slide6

Methodology

  • Matching: Age (within the same birth month), sex
  • Sample size: 120 cases and 600 controls
  • Ethical clearance & Written informed consent obtained
  • Data collection
    • Using questionnaires containing demographic characteristics; child characteristics (such as ethnicity); child health; household features, including amenities and wealth; social support; health-seeking behaviour traditional measures of access to health care
    • Distance and time calculation
  • Analysis:
    • Using Stata software ver 8.0
    • Conditional logistic regression
    • Likelihood ratio test to detect interaction
    • Correlation coefficients caculated for social and finacial variables
slide7

Table 1: Association between traditional indicators of access to health care and mortality in children under 5 years of age

slide8

Table 2: Association between primary caregiver social support indicators and mortality in children under 5 years of age

slide10
Table 3: Association between primary caregiver financial indicators of access to health care and child death
slide12

Strengths

  • Selection bias, recall bias, and non participation bias minimized
  • Wide range of confounders controlled
  • Limitations
  • DHSS population may not be representive as recent migrants and the transient population who are probably the most susceptible to social exclusion may have been excluded
  • Birth weight not include in multivariate analysis
slide13

Conclusion:

  • Among traditional measures only rural place of residence was significantly

associated with an increased risk of death before the age of 5 years

  • Various non-traditional measures, including caregivers’ support networks and their access to the financial resourceswere significantly associated with child death

Recommendation:

  • Strengthening of social support networks for children’s caregivers might be achieved through community group development and implementation of community systems
  • To improve their access to financial resources through tools such as micro -financing