title: Knowing a medical doctor is associated with reduced mortality among sick children consulting a paediatric ward in Guinea-Bissau, West Africa.
abstract: BACKGROUND
  To examine equity in access to public health services in Guinea-Bissau.
  
  
  METHODS
  The study was conducted in 2000-2001 at the emergency clinic of the only paediatric ward in Bissau. Mothers of all children from the study area were interviewed about previous care seeking and relations with anybody working in the health sector. All management actions in the emergency clinic were registered. In-hospital and subsequent community mortality was ascertained through community surveillance. The measured outcome was mortality risk within 30 days of first consultation.
  
  
  RESULTS
  We followed 1572 children with a first consultation. Of these, 8.2% died within 30 days. Acquaintance with a physician reduced 30-day mortality risk by 48% (95% CI: 18-66). The effect was strongest among post-neonatal children (54%; 95% CI: 18-74). Mortality within 30 days of consultation was also independently predicted by consultation after 7 PM, nurse team on duty, day of week and young mother. In a multivariate model, socioeconomic status and school education were not associated with 30-day mortality when acquaintance with a medical doctor was taken into account.
  
  
  CONCLUSIONS
  Favouritism may be a significant factor for quality of care and child mortality in developing countries. Interventions to improve hospital and health worker performance should be given high priority.
authors.affiliation: Projécto de Saúde Bandim, Bissau, Guinea-Bissau. mortenso@dadlnet.dk
authors.forename: M
authors.initials: M
authors.lastname: Sodemann
authors.forename: S
authors.initials: S
authors.lastname: Biai
authors.forename: M S
authors.initials: MS
authors.lastname: Jakobsen
authors.forename: P
authors.initials: P
authors.lastname: Aaby
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002662:Child Health Services / Q000592:standards* / Q000706:statistics & numerical data; D046688:Child Mortality; D002675:Child, Preschool; D003906:Developing Countries; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006169:Guinea-Bissau; D006297:Health Services Accessibility / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011368:Professional-Family Relations; D012959:Socioeconomic Factors