Distance to primary care facilities and healthcare utilization for preschool children in rural northwestern Burkina Faso: results from a surveillance cohort

Catherine E Oldenburg,Ying Lin,Mamadou Bountogo,Fanice Nyatigo,Elodie Lebas,Ali Sié,Thomas M Lietman,Idrissa Kouanda,Benjamin F Arnold,Valentin Boudo,Mamadou Ouattara,Jessica M Brogdon

doi:10.1186/s12913-021-06226-5

Abstract

BackgroundDelays in care-seeking for childhood illness may lead to more severe outcomes. We evaluated whether community distance from a primary healthcare facility was associated with decreased healthcare utilization in a rural district of northwestern Burkina Faso.MethodsWe conducted passive surveillance of all government-run primary healthcare facilities in Nouna District, Burkina Faso from March 1 through May 31, 2020. All healthcare visits for children under 5 years of age were recorded on a standardized form for sick children. We recorded the age, sex, and community of residence of the child as well as any diagnoses and treatments administered. We calculated healthcare utilization per 100 child-months by linking the aggregate number of visits at the community level to the community’s population of children under 5 months per a census that was conducted from August 2019 through February 2020. We calculated the distance between each community and its corresponding healthcare facility and assessed the relationship between distance and the rate of healthcare utilization.ResultsIn 226 study communities, 12,676 primary healthcare visits were recorded over the three-month period. The median distance between the community and primary healthcare facility was 5.0 km (IQR 2.6 to 6.9 km), and median number of healthcare visits per 100 child-months at the community level was 6.7 (IQR 3.7 to 12.3). The rate of primary healthcare visits declined with increasing distance from clinic (Spearman’s rho − 0.42, 95% CI − 0.54 to − 0.31, P < 0.0001). This relationship was similar for cause-specific clinic visits (including pneumonia, malaria, and diarrhea) and for antibiotic prescriptions.ConclusionsWe documented a distance decay effect between community distance from a primary healthcare facility and the rate of healthcare visits for children under 5. Decreasing distance-related barriers, for example by increasing the number of facilities or targeting outreach to more distant communities, may improve healthcare utilization for young children in similar settings.

Highlights

Delays in care-seeking for childhood illness may lead to more severe outcomes
A total of 44,064 children under 5 years of age were recorded on the census, and communities had a median of 151 children
The rate of primary healthcare visits declined with increasing distance from clinic (Spearman’s rho − 0.42, 95% Confidence interval (CI) − 0.54 to − 0.31, P < 0.0001)

Summary

Introduction

Delays in care-seeking for childhood illness may lead to more severe outcomes. We evaluated whether community distance from a primary healthcare facility was associated with decreased healthcare utilization in a rural district of northwestern Burkina Faso. Childhood mortality is declining globally, it is declining at different rates both across and within countries [1, 2]. Mortality rates tend to be higher in rural compared to urban areas, and within urban areas in informal settlement areas compared to more developed neighborhoods in cities [1, 3, 4]. The majority of post-neonatal childhood mortality in sub-Saharan Africa is infectious. Major drivers of persistently high childhood mortality are structural, including extreme poverty and lack of access to healthcare. In areas with declining childhood mortality, deaths often occur at home [5]. Barriers to accessing healthcare may result in subpopulations with increased risk of childhood mortality, even in settings where overall mortality rates are declining

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Discussion

Conclusion