title: The effect of distance on observed mortality, childhood pneumonia and vaccine efficacy in rural Gambia.
abstract: We investigated whether straight-line distance from residential compounds to healthcare facilities influenced mortality, the incidence of pneumonia and vaccine efficacy against pneumonia in rural Gambia. Clinical surveillance for pneumonia was conducted on 6938 children living in the catchment areas of the two largest healthcare facilities. Deaths were monitored by three-monthly home visits. Children living >5 km from the two largest healthcare facilities had a 2·78 [95% confidence interval (CI) 1·74-4·43] times higher risk of all-cause mortality compared to children living within 2 km of these facilities. The observed rate of clinical and radiological pneumonia was lower in children living >5 km from these facilities compared to those living within 2 km [rate ratios 0·65 (95% CI 0·57-0·73) and 0·74 (95% CI 0·55-0·98), respectively]. There was no association between distance and estimated pneumococcal vaccine efficacy. Geographical access to healthcare services is an important determinant of survival and pneumonia in children in rural Gambia.
authors.affiliation: Medical Research Council Unit, Banjul,The Gambia.
authors.forename: S M A
authors.initials: SM
authors.lastname: Zaman
authors.affiliation: Department of Disease Control,London School of Hygiene & Tropical Medicine,London,UK.
authors.forename: J
authors.initials: J
authors.lastname: Cox
authors.affiliation: Medical Research Council Unit, Banjul,The Gambia.
authors.forename: G C
authors.initials: GC
authors.lastname: Enwere
authors.affiliation: Medical Research Council Tropical Epidemiology Group, Department of Infectious Disease Epidemiology,London School of Hygiene & Tropical Medicine,London,UK.
authors.forename: C
authors.initials: C
authors.lastname: Bottomley
authors.affiliation: Department of Disease Control,London School of Hygiene & Tropical Medicine,London,UK.
authors.forename: B M
authors.initials: BM
authors.lastname: Greenwood
authors.affiliation: Medical Research Council Unit, Banjul,The Gambia.
authors.forename: F T
authors.initials: FT
authors.lastname: Cutts
mesh_terms: D002391:Catchment Area, Health; D002648:Child; D002675:Child, Preschool; D005260:Female; D005714:Gambia / Q000453:epidemiology; D040362:Geographic Information Systems; D006297:Health Services Accessibility; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D022242:Pneumococcal Vaccines / Q000276:immunology*; D011018:Pneumonia, Pneumococcal / Q000401:mortality* / Q000517:prevention & control*; D012307:Risk Factors; D012424:Rural Population; D014195:Travel
chemical_list: D022242:Pneumococcal Vaccines