Proximity to Health Care Facility Reduces the Risk of Co-morbidities and Severe Illness in Children with Acute Malaria in Rural African Communities
Objective: To investigate the relationship between physical accessibility to a health care facility and the risk of morbidity among children in a rural Gambian district. Methods: Consecutive children aged 6 months to 10 years attending a rural primary health care clinic in The Gambia with a confirmed diagnosis of malaria were assessed for the presence of co-morbidities. We then compared the prevalence of co-morbidities, number of co-morbidities and disease severity among the children, categorising them by the distance they had to travel to get to the Clinic. Findings: Residing beyond 10 km from the Clinic was associated with higher prevalence of co-morbidities (adjusted OR (95% CI): 2.5 (1.5, 4.4), P=0.001). Similarly, the number of co-morbidities increased with increasing distance from the Clinic. Incidences of severe malaria and severe illness were respectively 2.7 (1.2, 5.9) times and 3.2 (1.4, 6.9) times higher in distant villages compared with villages within 10 km from the Clinic. Residing more than 10 km away from the Clinic was also associated with a higher risk of anaemia, and severer grades of anaemia. Conclusion: Living far from a health facility increases the risk of a child dying from common childhood diseases. Such risk is likely to be considerably higher in remote rural communities with very limited efficient means of transportation and fewer choices of health care facilities. Introduction of free, well-resourced and easily accessible primary health care in such communities could enhance child survival.
Chidi Victor Nweneka*
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