Association between proximity to a health center and early childhood mortality in madagascar

Saori Kashima, Etsuji Suzuki, Toshiharu Okayasu, Razafimahatratra Louis, Akira Eboshida, S. V. Subramanian

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish
Article numbere38370
JournalPLoS One
Volume7
Issue number6
DOIs
Publication statusPublished - Jun 4 2012

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Madagascar
infant mortality
Infant Mortality
neonatal mortality
childhood
Health
confidence interval
households
Mortality
odds ratio
Mothers
exposure assessment
Confidence Intervals
global positioning systems
health status
anemia
health services
villages
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Association between proximity to a health center and early childhood mortality in madagascar. / Kashima, Saori; Suzuki, Etsuji; Okayasu, Toshiharu; Louis, Razafimahatratra; Eboshida, Akira; Subramanian, S. V.

In: PLoS One, Vol. 7, No. 6, e38370, 04.06.2012.

Research output: Contribution to journalArticle

Kashima, Saori ; Suzuki, Etsuji ; Okayasu, Toshiharu ; Louis, Razafimahatratra ; Eboshida, Akira ; Subramanian, S. V. / Association between proximity to a health center and early childhood mortality in madagascar. In: PLoS One. 2012 ; Vol. 7, No. 6.
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abstract = "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.",
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