Association between proximity to a health center and early childhood mortality in Madagascar.
OBJECTIVE: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance. METHODS: From birth records of subjects in the De...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Public Library of Science (PLoS)
2012-01-01
|
| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3366931?pdf=render |
| _version_ | 1828174435783278592 |
|---|---|
| author | Saori Kashima Etsuji Suzuki Toshiharu Okayasu Razafimahatratra Jean Louis Akira Eboshida S V Subramanian |
| author_facet | Saori Kashima Etsuji Suzuki Toshiharu Okayasu Razafimahatratra Jean Louis Akira Eboshida S V Subramanian |
| author_sort | Saori Kashima |
| collection | DOAJ |
| description | OBJECTIVE: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance. METHODS: From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1), nested within 584 village locations (level 2), and in turn nested within 22 regions (level 3). We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia. RESULTS: Compared with those who lived >1.5-3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0-10.0 km away from a health center were 1.36 (95% CI: 0.92-2.01) and 1.42 (95% CI: 1.06-1.90), respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status. CONCLUSIONS: Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve better infant health. |
| first_indexed | 2024-04-12T04:12:40Z |
| format | Article |
| id | doaj.art-0eae66caca0547c5981888f48a4cf012 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T04:12:40Z |
| publishDate | 2012-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-0eae66caca0547c5981888f48a4cf0122022-12-22T03:48:28ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0176e3837010.1371/journal.pone.0038370Association between proximity to a health center and early childhood mortality in Madagascar.Saori KashimaEtsuji SuzukiToshiharu OkayasuRazafimahatratra Jean LouisAkira EboshidaS V SubramanianOBJECTIVE: To evaluate the association between proximity to a health center and early childhood mortality in Madagascar, and to assess the influence of household wealth, maternal educational attainment, and maternal health on the effects of distance. METHODS: From birth records of subjects in the Demographic and Health Survey, we identified 12565 singleton births from January 2004 to August 2009. After excluding 220 births that lacked global positioning system information for exposure assessment, odds ratios (ORs) and their 95% confidence intervals (CIs) for neonatal mortality and infant mortality were estimated using multilevel logistic regression models, with 12345 subjects (level 1), nested within 584 village locations (level 2), and in turn nested within 22 regions (level 3). We additionally stratified the subjects by the birth order. We estimated predicted probabilities of each outcome by a three-level model including cross-level interactions between proximity to a health center and household wealth, maternal educational attainment, and maternal anemia. RESULTS: Compared with those who lived >1.5-3.0 km from a health center, the risks for neonatal mortality and infant mortality tended to increase among those who lived further than 5.0 km from a health center; the adjusted ORs for neonatal mortality and infant mortality for those who lived >5.0-10.0 km away from a health center were 1.36 (95% CI: 0.92-2.01) and 1.42 (95% CI: 1.06-1.90), respectively. The positive associations were more pronounced among the second or later child. The distance effects were not modified by household wealth status, maternal educational attainment, or maternal health status. CONCLUSIONS: Our study suggests that distance from a health center is a risk factor for early childhood mortality (primarily, infant mortality) in Madagascar by using a large-scale nationally representative dataset. The accessibility to health care in remote areas would be a key factor to achieve better infant health.http://europepmc.org/articles/PMC3366931?pdf=render |
| spellingShingle | Saori Kashima Etsuji Suzuki Toshiharu Okayasu Razafimahatratra Jean Louis Akira Eboshida S V Subramanian Association between proximity to a health center and early childhood mortality in Madagascar. PLoS ONE |
| title | Association between proximity to a health center and early childhood mortality in Madagascar. |
| title_full | Association between proximity to a health center and early childhood mortality in Madagascar. |
| title_fullStr | Association between proximity to a health center and early childhood mortality in Madagascar. |
| title_full_unstemmed | Association between proximity to a health center and early childhood mortality in Madagascar. |
| title_short | Association between proximity to a health center and early childhood mortality in Madagascar. |
| title_sort | association between proximity to a health center and early childhood mortality in madagascar |
| url | http://europepmc.org/articles/PMC3366931?pdf=render |
| work_keys_str_mv | AT saorikashima associationbetweenproximitytoahealthcenterandearlychildhoodmortalityinmadagascar AT etsujisuzuki associationbetweenproximitytoahealthcenterandearlychildhoodmortalityinmadagascar AT toshiharuokayasu associationbetweenproximitytoahealthcenterandearlychildhoodmortalityinmadagascar AT razafimahatratrajeanlouis associationbetweenproximitytoahealthcenterandearlychildhoodmortalityinmadagascar AT akiraeboshida associationbetweenproximitytoahealthcenterandearlychildhoodmortalityinmadagascar AT svsubramanian associationbetweenproximitytoahealthcenterandearlychildhoodmortalityinmadagascar |