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Childhood mortality and distance to health centers in Burkina Faso

Project team:  Heiko Becher, Anja Schoeps, Sabine Gabrysch

Collaborations within the department: Olaf Müller

External Collaborators:  Ali Sié, CRSN, Nouna, Burkina Faso

Funding period: 2010-2011

It is of interest whether childhood mortality is clustered in particular areas and whether factors like distance to health centers are predictors of childhood mortality. These research questions have been investigated in our institute in collaboration with the Centre du recherche en Santé de Nouna, Burkina Faso over the last years.

More recently, we investigated the relation between distance to health facilities, measured as continuous travel time, and mortality among infants and children younger than 5 years of age in rural Burkina Faso, an area with low health facility density. The study included 24,555 children born between 1993 and 2005 in the Nouna Health and Demographic Surveillance System. The average walking time from each village to the closest health facility was obtained for both the dry and the rainy season, and its effect on infant (<1 year), child (1-4 years), and under-5 mortality overall was analyzed by Cox regression. The authors observed 3,426 childhood deaths, corresponding to a 5-year survival of 85%. Walking distance was significantly related to both infant and child mortality, although the shape of this effect varied distinctly between the 2 age groups.

Overall, under-5 mortality, adjusted for confounding, was more than 50% higher at a distance of 4 hours compared with having a health facility in the village (P < 0.0001, 2 sided). The region of residence was an additional determinant for under-5 mortality. The findings of this study emphasize the importance of geographic accessibility of health care for child survival in sub-Saharan Africa and demonstrate the need to improve health-care access to achieve the Millennium Development Goals.

Publications: 

Schoeps A, Gabrysch S, Niamba L, Sié A, Becher H (2011): The Effect of Distance to Health Care Facilities on Childhood Mortality in rural Burkina Faso. Am J Epid 173:492–498.