Distance from Healthcare Facilities Is Associated with Increased Morbidity of Acute Infection in Pediatric Patients in Matiari, Pakistan.

Elise Corden,Najeeb Rahman,Lubaina Ehsan,Fayaz Umrani,William Adorno,Saman Hasan Siddiqui,Fatima Zulqarnain,Aman Shrivastava,Muhammad Faraz Raghib,Sheraz Ahmed,Rafey Ali,Najeeha T Iqbal,Yash Sharma,Syed Asad Ali,Sana Syed,Sean R Moore

doi:10.3390/ijerph182111691

Abstract

The relationship between environmental factors and child health is not well understood in rural Pakistan. This study characterized the environmental factors related to the morbidity of acute respiratory infections (ARIs), diarrhea, and growth using geographical information systems (GIS) technology. Anthropometric, address and disease prevalence data were collected through the SEEM (Study of Environmental Enteropathy and Malnutrition) study in Matiari, Pakistan. Publicly available map data were used to compile coordinates of healthcare facilities. A Pearson correlation coefficient (r) was used to calculate the correlation between distance from healthcare facilities and participant growth and morbidity. Other continuous variables influencing these outcomes were analyzed using a random forest regression model. In this study of 416 children, we found that participants living closer to secondary hospitals had a lower prevalence of ARI (r = 0.154, p < 0.010) and diarrhea (r = 0.228, p < 0.001) as well as participants living closer to Maternal Health Centers (MHCs): ARI (r = 0.185, p < 0.002) and diarrhea (r = 0.223, p < 0.001) compared to those living near primary facilities. Our random forest model showed that distance has high variable importance in the context of disease prevalence. Our results indicated that participants closer to more basic healthcare facilities reported a higher prevalence of both diarrhea and ARI than those near more urban facilities, highlighting potential public policy gaps in ameliorating rural health.

Highlights

IntroductionChildren in rural areas of countries often lack ready access to adequate healthcare
This study has investigated the relationship between geospatial factors and the morbidity of acute infections in the pediatric population, acute respiratory infections (ARIs) and diarrhea
Many factors contribute to the growth and health of pediatric patients, including proximity and access to quality healthcare and timely nutritional and medical interventions

Summary

Introduction

Children in rural areas of countries often lack ready access to adequate healthcare. In. Pakistan, a country that spends only 3.4% of its total gross domestic product (GDP) on healthcare, health-related resources are often described to be insufficiently funded or poorly allocated [1]. Healthcare in Pakistan is delivered through a three-tiered system. The first tier, primary care centers, includes Basic Health Units (BHUs) and Rural Health Centers (RHCs)

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