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Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis
OBJECTIVES: Few studies have systematically examined the effects of barriers such as distance to health facilities on child survival in low- and middle-income countries. Our primary objective was to estimate the effect of proximity to health facilities on child survival in low- and middle-income cou...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Group
2012
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400076/ https://www.ncbi.nlm.nih.gov/pubmed/22798257 http://dx.doi.org/10.1136/bmjopen-2012-001196 |
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author | Okwaraji, Yemisrach Behailu Edmond, Karen M |
author_facet | Okwaraji, Yemisrach Behailu Edmond, Karen M |
author_sort | Okwaraji, Yemisrach Behailu |
collection | PubMed |
description | OBJECTIVES: Few studies have systematically examined the effects of barriers such as distance to health facilities on child survival in low- and middle-income countries. Our primary objective was to estimate the effect of proximity to health facilities on child survival in low- and middle-income countries. The secondary objective was to compare effects in different age categories (perinatal (28 weeks of gestation to 1 week of age), neonatal (0–27 days), infant (0–11 months) and child (0–59 months) mortality). DESIGN: A systematic review and meta-analysis was conducted of studies published from 1980 to 2012 that assessed the effect of proximity to health facilities on child survival in low- and middle-income countries. Synthesis was by random-effects meta-analysis, and variation between studies was investigated by meta-regression. SETTING: Low- and middle-income countries. PARTICIPANTS: 13 studies were included in the meta-analysis, 11 from low-income and two from middle-income countries and none were from remote areas. PRIMARY OUTCOME MEASURES: The primary outcome measures of interest were perinatal, neonatal, infant and child mortality. RESULTS: Overall, children who lived farthest from health facilities were more likely to die compared with those who lived closer (OR 1.32, 95% CI 1.19 to 1.47). This effect appeared stronger during the perinatal (OR 2.76, 95% CI 1.80 to 4.24) and neonatal (OR 1.98, 95% CI 1.43 to 2.72) periods compared with the infant (OR 1.18, 95% CI 1.0 to 1.38) and under-5 (OR 1.20, 95% CI 1.04 to 1.39) periods. CONCLUSIONS: Proximity to health facilities appears to be an important determinant of under-5 mortality in low- and middle-income countries, especially in the perinatal and neonatal periods. Higher quality studies are needed, which examine the effect of access to health services on child survival, especially studies from remote areas and hard to reach populations. |
format | Online Article Text |
id | pubmed-3400076 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2012 |
publisher | BMJ Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-34000762012-07-23 Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis Okwaraji, Yemisrach Behailu Edmond, Karen M BMJ Open Epidemiology OBJECTIVES: Few studies have systematically examined the effects of barriers such as distance to health facilities on child survival in low- and middle-income countries. Our primary objective was to estimate the effect of proximity to health facilities on child survival in low- and middle-income countries. The secondary objective was to compare effects in different age categories (perinatal (28 weeks of gestation to 1 week of age), neonatal (0–27 days), infant (0–11 months) and child (0–59 months) mortality). DESIGN: A systematic review and meta-analysis was conducted of studies published from 1980 to 2012 that assessed the effect of proximity to health facilities on child survival in low- and middle-income countries. Synthesis was by random-effects meta-analysis, and variation between studies was investigated by meta-regression. SETTING: Low- and middle-income countries. PARTICIPANTS: 13 studies were included in the meta-analysis, 11 from low-income and two from middle-income countries and none were from remote areas. PRIMARY OUTCOME MEASURES: The primary outcome measures of interest were perinatal, neonatal, infant and child mortality. RESULTS: Overall, children who lived farthest from health facilities were more likely to die compared with those who lived closer (OR 1.32, 95% CI 1.19 to 1.47). This effect appeared stronger during the perinatal (OR 2.76, 95% CI 1.80 to 4.24) and neonatal (OR 1.98, 95% CI 1.43 to 2.72) periods compared with the infant (OR 1.18, 95% CI 1.0 to 1.38) and under-5 (OR 1.20, 95% CI 1.04 to 1.39) periods. CONCLUSIONS: Proximity to health facilities appears to be an important determinant of under-5 mortality in low- and middle-income countries, especially in the perinatal and neonatal periods. Higher quality studies are needed, which examine the effect of access to health services on child survival, especially studies from remote areas and hard to reach populations. BMJ Group 2012-07-12 /pmc/articles/PMC3400076/ /pubmed/22798257 http://dx.doi.org/10.1136/bmjopen-2012-001196 Text en © 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode. |
spellingShingle | Epidemiology Okwaraji, Yemisrach Behailu Edmond, Karen M Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis |
title | Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis |
title_full | Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis |
title_fullStr | Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis |
title_full_unstemmed | Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis |
title_short | Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis |
title_sort | proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis |
topic | Epidemiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3400076/ https://www.ncbi.nlm.nih.gov/pubmed/22798257 http://dx.doi.org/10.1136/bmjopen-2012-001196 |
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