title: Mobile primary healthcare services and health outcomes of children in rural Namibia.
abstract: BACKGROUND
  In rural areas of Namibia where health facilities are far apart, health outcomes are poor among high utilization groups such as pregnant women and children. Among children, orphans and vulnerable children (OVC) are generally more affected than non-OVC. This study assessed the health changes of orphans and other vulnerable and non-vulnerable children visiting a mobile clinic in rural Namibia.
  
  
  METHODS
  Over a 6 month period, information on immunization status, diagnosis of anemia, skin and intestinal disorders, nutrition, dental disorders and referrals was collected from the records of a mobile clinic serving farms and surrounding areas in parts of rural Namibia. Data were compared for all children with visits in months 1 or 2 (baseline) and a visit in months 5 or 6 (follow up). Data for a cohort of children seen at both time points (the longitudinal group) were also analyzed.
  
  
  RESULTS
  For all children, there was significant reduction in outstanding immunizations (5% to 1% p<0.0001), skin and intestinal parasites (15.5% to 0.2% p<0.0001), and stunting (26.9% to 14.2% p<0.0001) between baseline and follow up. Within the longitudinal group, reductions were observed in the prevalence of anemia (1.9% to 0.5% p<0.0001), incomplete immunizations (6.5% to <1% p<0.0001), and parasitic infections (16.9% to 0.2% p<0.0001) between the two time points. At baseline, orphans were more likely to have incomplete immunizations and parasitic infections. Among orphans, incomplete immunizations declined from 25% to 0 (p<0.001) while parasitic infections decreased from 22.7% to 0 (p<0.001). Among other vulnerable children incomplete immunizations declined from 5% to 1% (p=0.002), as did skin and parasitic infestations (17.2% to 0.3% p<0.001).
  
  
  CONCLUSIONS
  Regular mobile clinic visits improved the health indices of child attendees. The greatest change was among OVC whose disease burden was greater at baseline. Mobile clinics may be an effective intervention in hard-to-reach, resource-limited settings.
authors.affiliation: Center for Global Health and Development, Boston University, Boston, Massachusetts, USA. ehimen@bu.edu
authors.forename: Ehimen
authors.initials: E
authors.lastname: Aneni
authors.forename: Ingrid H
authors.initials: IH
authors.lastname: De Beer
authors.forename: Laura
authors.initials: L
authors.lastname: Hanson
authors.forename: Bas
authors.initials: B
authors.lastname: Rijnen
authors.forename: Alana T
authors.initials: AT
authors.lastname: Brenan
authors.forename: Frank G
authors.initials: FG
authors.lastname: Feeley
mesh_terms: D001837:Body Weights and Measures; D002648:Child; D054540:Child, Orphaned; D002675:Child, Preschool; D005260:Female; D006304:Health Status; D006801:Humans; D007114:Immunization / Q000706:statistics & numerical data; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009276:Namibia / Q000453:epidemiology; D009909:Oral Health / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000458:organization & administration / Q000706:statistics & numerical data*; D035862:Vulnerable Populations; D055815:Young Adult