title: The impact of distance of residence from a peripheral health facility on pediatric health utilisation in rural western Kenya.
abstract: OBJECTIVE
  To explore the impact of distance on utilisation of peripheral health facilities for sick child visits in Asembo, rural western Kenya.
  
  
  METHODS
  As part of a demographic surveillance system (DSS), censuses of all households in the Asembo population of 55,000 are conducted three times a year, data are collected at all outpatient pediatric visits in seven DSS clinics in Asembo, and all households are GIS-mapped and linkable to a child's unique DSS identification number. Between May 1, 2003 and April 30, 2004, 3501 clinic visits were linked to 2432 children among 10,973 DSS-resident children < 5 years of age.
  
  
  RESULTS
  Younger children and children with more severe illnesses travelled further for clinic visits. The median distance travelled varied by clinic. The rate of clinic visits decreased linearly at 0.5 km intervals up to 4 km, after which the rate stabilised. Using Poisson regression, controlling for the nearest DSS clinic for each child, socio-economic status and maternal education, and accounting for household clustering of children, for every 1 km increase in distance of residence from a DSS clinic, the rate of clinic visits decreased by 34% (95% CI, 31-37%) from the previous kilometer.
  
  
  CONCLUSIONS
  Achieving equity in access to health care for children in rural Kenya will require creative strategies to address a significant distance-decay effect in health care utilisation.
authors.affiliation: Kenya Medical Research Institute (KEMRI), Kisumu, Kenya. dfeikin@ke.cdc.gov
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Feikin
authors.forename: Ly Minh
authors.initials: LM
authors.lastname: Nguyen
authors.forename: Kubaje
authors.initials: K
authors.lastname: Adazu
authors.forename: Maurice
authors.initials: M
authors.lastname: Ombok
authors.forename: Allan
authors.initials: A
authors.lastname: Audi
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.forename: Kim A
authors.initials: KA
authors.lastname: Lindblade
mesh_terms: D000367:Age Factors; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003906:Developing Countries; D004522:Educational Status; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya; D008297:Male; D011159:Population Surveillance; D012111:Residence Characteristics / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012923:Social Class