The effect of distance to formal health facility on childhood mortality in rural Tanzania, 2005–2007

Abstract

Background : Major improvements are required in the coverage and quality of essential childhood interventions to achieve Millennium Development Goal Four (MDG 4). Long distance to health facilities is one of the known barriers to access. We investigated the effect of networked and Euclidean distances from home to formal health facilities on childhood mortality in rural Tanzania between 2005 and 2007.

Methods : A secondary analysis of data from a cohort of 28,823 children younger than age 5 between 2005 and 2007 from Ifakara Health and Demographic Surveillance System was carried out. Both Euclidean and networked distances from the household to the nearest health facility were calculated using geographical information system methods. Cox proportional hazard regression models were used to investigate the effect of distance from home to the nearest health facility on child mortality.

Results : Children who lived in homes with networked distance >5 km experienced approximately 17% increased mortality risk (HR=1.17; 95% CI 1.02–1.38) compared to those who lived <5 km networked distance to the nearest health facility. Death of a mother (HR=5.87; 95% CI 4.11–8.40), death of preceding sibling (HR=1.9; 95% CI 1.37–2.65), and twin birth (HR=2.9; 95% CI 2.27–3.74) were the strongest independent predictors of child mortality.

Conclusions : Physical access to health facilities is a determinant of child mortality in rural Tanzania. Innovations to improve access to health facilities coupled with birth spacing and care at birth are needed to reduce child deaths in rural Tanzania.

• child mortality
• Health and Demographic Surveillance System
• health facility
• distance
• Tanzania

Acknowledgements

The authors are grateful to the INDEPTH Network for the financial support used to undertake this work and University of Witwatersrand for the scientific skills development. They are also grateful to Iganga/Mayuge Health and Demographic Surveillance Site management for allowing time to carry out this study. The authors highly acknowledge the hard work and commitment of the field and data team of Ifakara Health and Demographic Surveillance Site (IHDSS). They are thankful to the residents of the IHDSS for offering their time for interviews and consistently sharing valuable information over the years. The authors are also grateful to Dr. Rose Nathan for the mentorship provided during my time in Ifakara. The authors are also grateful to Mr. Robert Sumaya for the assistance provided in GIS techniques.