Supply-Side Barriers to the Use of Public Healthcare Facilities for Childhood Illness Care in Rural Zambia: A Cross-Sectional Study Linking Data from a Healthcare Facility Census to a Household Survey.

Keiji Mochida,Daisuke Nonaka,Jun Kobayashi,Jason Wamulume

doi:10.3390/ijerph18105409

Abstract

Child mortality due to malaria and diarrhea can be reduced if proper treatment is received timely at healthcare facilities, but various factors hinder this. The present study assessed the associations between the use of public healthcare facilities among febrile/diarrheal children in rural Zambia and supply-side factors (i.e., the distance from the village to the nearest facility and the availability of essential human resources and medical equipment at the facility). Data from the Demographic and Health Survey 2018 and the Health Facility Census 2017 were linked. Generalized linear mixed models were used to assess the associations, controlling for clustering and other variables. The median distances to the nearest facility were 4.5 km among 854 febrile children and 4.6 km among 813 diarrheal children. Children who were over 10 km away from the facility were significantly less likely to use it, compared to those within 5 km (fever group: odds ratio (OR) = 0.36, 95% confidence interval (CI) = 0.20–0.66; diarrhea group: OR = 0.30, 95% CI = 0.18–0.51). The availability of human resources and equipment was, however, not significantly associated with facility use. Poor geographic access could be a critical barrier to facility use among children in rural Zambia.

Highlights

Though child mortality has considerably decreased globally in recent years, the mortality rate is still high in sub-Saharan Africa
The main finding of the present study was the fact that, healthcare facility use decreased with increased distance, there was no significant difference in facility use between children living within 5 km from the nearest healthcare facility and those living between 5 and 10 km away
Poor geographic access could be a critical barrier to obtaining fever and diarrhea care at a healthcare facility among children in rural Zambia, and the negative impact is substantial if the facility is located 10 km or more away from villages

Summary

Introduction

Though child mortality has considerably decreased globally in recent years, the mortality rate is still high in sub-Saharan Africa. Malaria and diarrhea are the major causes of child mortality in many countries in the region, where 257,000 and 235,000 children under five died due to these illnesses in 2017, respectively [2]. Barriers to health service use in low-income countries in Asia have been categorized into supply- and demand-side barriers [3]. According to this framework, a systematic review, which investigated the factors influencing healthcareseeking for childhood pneumonia, diarrheal diseases, and malaria in low- and middleincome countries, summarized the geography and cost of healthcare as supply-side barriers and the severity of illness, socioeconomic status, and sex of the child as demand-side barriers [4]. Supply- and demand-side information are collected separately by facility-based and household surveys, so it is impossible to comprehensively understand

Methods

Results

Discussion

Conclusion