Impact of spatial distribution of health services on child morbidity and mortality


  • NIH-National Institute of Child Health and Human Development

End Date:

  • Ongoing

Impact of spatial distribution of health services on child morbidity and mortality

Globally, fifty percent of deaths in children occur in sub-Saharan Africa. If the current trend persists, Sub-Saharan Africa will not reach Millennium Development Goal 4 (reduce child mortality by two thirds) until 2165, 150 years after the target date. Treatable or preventable infectious diseases such as pneumonia, malaria, and diarrhea, account for 61% of childhood deaths after the neonatal period. Therefore, a large proportion of deaths from birth to the fifth birthday are attributable to a handful of common causes that are avoidable through existing interventions, many of which are delivered through health facilities. It seems probable that access to these life-saving interventions is limited by the health systems that deliver them.

The objective of the proposed work is to use innovative spatial techniques to quantify the contribution of access to health services in reducing childhood morbidity and mortality. We will use large, existing datasets to describe the relationship between health outcomes and geographic distribution of health services at different spatial scales. Ultimately, the goal of such an approach is to provide evidence regarding the impact of health systems infrastructure on disease burden, independent of disease-specific interventions. The impact of health systems is difficult to measure and large comparison studies or randomized trials are often not feasible. However, applying spatial statistical techniques to this problem can provide evidence for causal relationships in the absence of a counterfactual.

W. P. O'Meara, A. Platt, V. Naanyu, D. Cole, S. Ndege, "Spatial autocorrelation in uptake of antenatal care and relationship to individual, household and village-level factors: results from a community-based survey of pregnant women in six districts in western Kenya" International Journal of Health Geographics 12:55 (2013)

A retrospective cohort study to quantify the contribution of health systems to child survival in Kenya: 1996-2014 Rebecca Anthopolos, Ryan Simmons, Wendy Prudhomme O'Meara, Scientific Reports (IN PRESS)

A. Wesolowski, W. Prudhomme O'Meara, N. Eagle, A.Tatem, C. Buckee "Evaluating spatial interaction models for regional mobility in Sub-Saharan Africa", PLoS Computational Biology 11(7): e1004267 (2015)

A. Wesolowski, W. Prudhomme O'Meara, A.Tatem, S. Ndege, N. Eagle, C. Buckee "Quantifying the impact of accessibility on preventative healthcare in Sub-Saharan Africa", Epidemiology, 26:223—228 (2015)

Health systems are the foundational infrastructure through which life-saving interventions are delivered. However, their impact on population health is difficult to measure. Our analysis of large-scale survey data reveals important associations between health systems characteristics and child survival in Kenya, independent of utilization or specific interventions, and lends weight to the argument that user fees for child services are detrimental to child survival. Furthermore, the presence of highly trained staff do not appear to be the limiting factor in Kenya. Instead, more attention should be given to understanding the role of the private sector and investment in improving the distribution of health services infrastructure.