title: Effect of geographical access to health facilities on child mortality in rural Ethiopia: a community based cross sectional study.
abstract: BACKGROUND
  There have been few studies that have examined associations between access to health care and child health outcomes in remote populations most in need of health services. This study assessed the effect of travel time and distance to health facilities on mortality in children under five years in a remote area of rural north-western Ethiopia.
  
  
  RESULTS
  This study involved a randomly selected cross sectional survey of 2,058 households. Data were collected during home visits to all resident women of reproductive age (15-49 years). A geographic information system (GIS) was used to map all households and the only health centre in the district. The analysis was restricted to 2,206 rural children who were under the age of five years during the five years before the survey. Data were analysed using random effects Poisson regression. 90.4% (1,996/2,206) of children lived more than 1.5 hours walk from the health centre. Children who lived ≥1.5 hrs from the health centre had a two to three fold greater risk of death than children who lived <1.5 hours from the health centre (children with travel time 1.5-<2.5 hrs adjusted relative risk [adjRR] 2.3[0.95-5.6], travel time 2.5-<3.5 hrs adjRR 3.1[1.3-7.4] and travel time 3.5-<6.5 hrs adjRR 2.5[1.1-6.2]).
  
  
  CONCLUSIONS
  Distance to a health centre had a marked influence on under five mortality in a poor, rural, remote area of Ethiopia. This study provides important information for policy makers on the likely impact of new health centres and their most effective location in remote areas.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom. yemisrach.okwaraji@lshtm.ac.uk
authors.forename: Yemisrach B
authors.initials: YB
authors.lastname: Okwaraji
authors.forename: Simon
authors.initials: S
authors.lastname: Cousens
authors.forename: Yemane
authors.initials: Y
authors.lastname: Berhane
authors.forename: Kim
authors.initials: K
authors.lastname: Mulholland
authors.forename: Karen
authors.initials: K
authors.lastname: Edmond
mesh_terms: D046688:Child Mortality; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005002:Ethiopia / Q000453:epidemiology; D005191:Family Characteristics; D005260:Female; D040362:Geographic Information Systems; D005843:Geography; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D025341:Principal Component Analysis; D012044:Regression Analysis; D012423:Rural Health / Q000706:statistics & numerical data*; D013997:Time Factors