Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis
- 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- 2School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
- Correspondence to Yemisrach Behailu Okwaraji;
- Received 27 March 2012
- Accepted 18 June 2012
- Published 12 July 2012
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.
To cite: Okwaraji YB, Edmond KM. Proximity to health services and child survival in low- and middle-income countries: a systematic review and meta-analysis. BMJ Open 2012;2:e001196. doi:10.1136/bmjopen-2012-001196
Contributors All authors contributed to conception and design of the review. All authors performed the abstraction and analysis of the data. All authors drafted and revised the manuscript. All authors read and approved the final version of the manuscript.
Funding YBO was funded by the Research Council Norway (grant number 190257). The funders played no role in the study design, collection, analysis, interpretation of data, writing of report or in the decision to submit the paper for publication. They accept no responsibility for the contents.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All original data extraction are available from the corresponding author at . Full details on quality assessment are available in the supplemental documents submitted with this article.
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