The Effect of Distance to Health-Care Facilities on Childhood Mortality in Rural Burkina Faso

摘要

This study aims to investigate the relation between distance to health facilities, measured as continuous travelntime, and mortality among infants and children younger than 5 years of age in rural Burkina Faso, an area with lownhealth facility density. The study included 24,555 children born between 1993 and 2005 in the Nouna Health andnDemographic Surveillance System. The average walking time from each village to the closest health facility wasnobtained for both the dry and the rainy season, and its effect on infant (<1 year), child (1–4 years), and under-5nmortality overall was analyzed by Cox regression. The authors observed 3,426 childhood deaths, corresponding tona 5-year survival of 85%. Walking distance was significantly related to both infant and child mortality, although thenshape of this effect varied distinctly between the 2 age groups. Overall, under-5 mortality, adjusted for confounding,nwas more than 50%higher at a distance of 4 hours compared with having a health facility in the village (P < 0.0001,n2 sided). The region of residence was an additional determinant for under-5 mortality. The findings of this studynemphasize the importance of geographic accessibility of health care for child survival in sub-Saharan Africa andndemonstrate the need to improve health-care access to achieve the Millennium Development Goals.