Abstract
ObjectiveAlthough distance has been identified as an important barrier to care, evidence for an effect of distance to care on child mortality is inconsistent. We investigated the association of distance to care with self‐reported care seeking behaviours, neonatal and post‐neonatal under‐five child mortality in rural areas of Burkina Faso.MethodsWe performed a cross‐sectional survey in 14 rural areas from November 2014 to March 2015. About 100 000 women were interviewed on their pregnancy history and about 5000 mothers were interviewed on their care seeking behaviours. Euclidean distances to the closest facility were calculated. Mixed‐effects logistic and Poisson regressions were used respectively to compute odds ratios for care seeking behaviours and rate ratios for child mortality during the 5 years prior to the survey.ResultsThirty per cent of the children lived more than 7 km from a facility. After controlling for confounding factors, there was a strong evidence of a decreasing trend in care seeking with increasing distance to care (P ≤ 0.005). There was evidence for an increasing trend in early neonatal mortality with increasing distance to care (P = 0.028), but not for late neonatal mortality (P = 0.479) and post‐neonatal under‐five child mortality (P = 0.488). In their first week of life, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility (RR = 1.18; 95%CI 1.00, 1.39; P = 0.056). In the late neonatal period, despite the lack of evidence for an association of mortality with distance, it is noteworthy that rate ratios were consistent with a trend and similar to or larger than estimates in early neonatal mortality. In this period, neonates living 7 km or more from a facility had an 18% higher mortality rate than neonates living within 2 km of a facility (RR = 1.18; 95%CI 0.92, 1.52; P = 0.202). Thus, the lack of evidence may reflect lower power due to fewer deaths rather than a weaker association.ConclusionWhile better geographic access to care is strongly associated with increased care seeking in rural Burkina Faso, the impact on child mortality appears to be marginal. This suggests that, in addition to improving access to services, attention needs to be paid to quality of those services.
Highlights
Despite a large reduction in under-five deaths worldwide from 1990 to 2015, scenario-based projections suggest that about two-thirds of all sub-Saharan African countries will need to accelerate their progress to achieve the Sustainable Development Goal (SDG) target of 25 or fewer under-five deaths per 1000 live births by 2030 [1]
While there was some evidence for an increase in the neonatal mortality rate with increasing distance to care (P = 0.014), no evidence was found for an increase in the post-neonatal under-five child mortality rate with increasing distance (P = 0.488)
In the neonatal period, evidence for an effect of distance to care on mortality was observed in the early neonatal period (P = 0.028), but not in the late neonatal period rate ratios were consistent with a trend (P = 0.479)
Summary
Despite a large reduction in under-five deaths worldwide from 1990 to 2015, scenario-based projections suggest that about two-thirds of all sub-Saharan African countries will need to accelerate their progress to achieve the Sustainable Development Goal (SDG) target of 25 or fewer under-five deaths per 1000 live births by 2030 [1]. An analysis of five countries using the Lives Saved Tool (LiST) estimated that increases in coverage of obstetric and newborn care accounted for 33% to 44% of averted neonatal deaths depending on country, while increased coverage of measures to prevent and treat infections accounted respectively for 28% to 72% and for 2% to 10% of averted post-neonatal under-five deaths [2]. Poor coverage of effective interventions for preventing child deaths has been attributed to weaknesses in both provision of and demand for services [3, 4]. Sarrassat et al Child mortality in Burkina Faso volume 00 no 00 provision of services through better access to good-quality care could potentially reduce child mortality
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