Objective To assess whether traditional measures of access to health care (distance and travel time to a facility) and non-traditional measures (social and financial support indicators) are associated with mortality among children under 5 years of age in the Gambia. Methods We conducted a case-control study in a population under demographic surveillance. Cases (n= 140) were children under 5 years of age who died between 31 December 2003 and 30 April 2006. Each case was matched in age and sex to five controls (n = 700). Information was gathered by interviewing primary caregivers. The data were analysed using conditional logistic regression. Findings Of traditional measures of access, only rural versus urban/periurban residence was important: children from rural areas were more likely to die (OR: 4.9; 95% confidence interval, Cl: 1.2-20.2). For non-traditional measures, children were more likely to die if their primary caregivers lacked help with meal preparation (OR: 2.3; 95% Cl: 1.2-4.1), had no one to relax with (OR: 1.8; 95% Cl: 1.1-2.9), had no one who could offer good advice (OR: 23.1; 95% Cl: 4.3-123.4), had little say over how earned money was spent (OR: 12.7; 95% Cl: 1.3-127.6), were unable to cut spending for health care (OR: 2.5; 95% Cl: 1.5-4.2) or had to carry out odd jobs to pay for the care (OR: 3.4; 95% Cl: 2.1-5.5). A protective effect was observed when the caregiver had other children to care for (OR: 0.2; 95% Cl: 0.1-0.5). Conclusion Improving access to health-care for children in the Gambia and similar settings is not simply a matter of reducing travel time and distance to a health facility, but requires improvements in caregivers' support networks and their access to the financial resources they need.
CITATION STYLE
Rutherford, M. E., Dockerty, J. D., Jasseh, M., Howie, S. R. C., Herbison, P., Jeffries, D. J., … Hill, P. C. (2009). Access to health care and mortality of children under 5 years of age in the Gambia: A case-control study. Bulletin of the World Health Organization, 87(3), 216–224. https://doi.org/10.2471/BLT.08.052175
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