Background There have been few studies which 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.
Methods 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.
Results 90.4% (1,996/2,206) of children lived more than 1.5 hours walk from the health centre. Children who lived >1.5hrs from the health centre had a two–three fold greater risk of death than children who lived<1.5 hours from the health centre (children with travel time 1.5–<2.5hrs adjusted relative risk [adjRR] 2.3[0.95–5.6], travel time 2.5–<3.5hrs adjRR 3.1[1.3–7.4] and travel time 3.5–<6.5hrs adjRR 2.5[1.1–6.2]).
Conclusion 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.
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