The impact of primary health care on malaria morbidity - Defining access by disease burden
Tropical Medicine and International Health
Fogarty International Center, National Institutes of Health, Bethesda, MD, United States; KEMRI/Wellcome Trust Collaborative Program, Nairobi, Kenya; Kenya Medical Research Institute, CGMRC/Wellcome Trust Collaborative Program, Kilifi, Kenya; Ministry of Health, Kilifi, Kenya
Objectives Primary care facilities are increasingly becoming the focal point for distribution of malaria intervention strategies, but physical access to these facilities may limit the extent to which communities can be reached. To investigate the impact of travel time to primary care on the incidence of hospitalized malaria episodes in a rural district in Kenya. Methods The incidence of hospitalized malaria in a population under continuous demographic surveillance was recorded over 3 years. The time to travel to the nearest primary health care facility was calculated for every child between birth and 5 years of age and trends in incidence of hospitalized malaria as a function of travel time were evaluated. Results The incidence of hospitalized malaria more than doubled as travel time to the nearest primary care facility increased from 10 min to 2 h. Good access to primary health facilities may reduce the burden of disease by as much as 66%. Conclusions Our results highlight both the potential of the primary health care system in reaching those most at risk and reducing the disease burden. Insufficient access is an important risk factor, one that may be inequitably distributed to the poorest households. © 2008 Blackwell Publishing Ltd.
child health; disease control; health care; malaria; morbidity; travel time; article; child; disease surveillance; health care access; health care facility; hospital admission; hospital patient; human; infant; Kenya; major clinical study; malaria; morbidity; newborn; outpatient care; preschool child; primary health care; rural health care; Ambulatory Care Facilities; Child, Preschool; Endemic Diseases; Health Services Accessibility; Health Services Research; Hospitalization; Humans; Incidence; Infant; Infant, Newborn; Kenya; Malaria; Primary Health Care; Residence Characteristics; Rural Health; Time Factors; Travel; Africa; East Africa; Kenya; Sub-Saharan Africa