Geographical accessibility to healthcare and malnutrition in Rwanda

Aoun, Nael; Matsuda, Hirotaka; Sekiyama, Makiko

doi:10.1016/j.socscimed.2015.02.004

Cited by 57 publications

(37 citation statements)

References 32 publications

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“…Low birth weight means more depletion of already low stores of key growth nutrients, which the mother’s breast milk continues to lack due to poor maternal nutritional status, thus resulting in a prolonged lack in these children. The findings of this study support those of previous ones that have consistently shown household wealth status to have a substantial protective effect against all the indicators of child undernutrition [38,45,57,58,66]. In countries where contrary findings have been reported, scaling up access to quality public health services was the point that marked the difference [67].…”

Section: Discussionsupporting

confidence: 90%

“…Similar findings have been documented in Tanzania [56] and other low-income countries such as Nigeria [45] and Ethiopia [18,58]. Though a group of evidence shows that maternal nutritional status has no effect on the composition of breast milk, this may not be the case for some key growth micronutrients like vitamin A, iodine, riboflavin, thiamine, and others [7].…”

Section: Discussionsupporting

confidence: 74%

“…Additionally, smaller than average babies experience feeding problems, a factor involved in undernutrition, even in this study [55]. A number of studies have shown maternal education to provide protective effects against all under-nutrition indicators in children [36,45,46,56,57,58,59,60]. The findings of this study are inconsistent with the results of the studies in terms of growth retardation and underweight children, with which no association was found.…”

Section: Discussionmentioning

confidence: 91%

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Factors Associated with Stunting among Children Aged 0 to 59 Months from the Central Region of Mozambique

et al. 2017

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The objective of this study was to identify the major socio-demographic, health, and environmental determinants of stunting among children aged 0–59 months from the Tete province (Mozambique) and offering useful information for future healthcare strategies and interventions. A case-control study was conducted among 282 (162 boys; 120 girls) children under five years of age from the central region of Mozambique between 1 May and 3 June 2014. Children with stunting (HAZ < −2 SD according to the WHO Child Growth Standards in 2006) were considered as cases and those who had a Z-score < −2 SD were considered as controls. We collected data related to mothers and children and their environment, and they were assessed in two groups to find a possible association. The software used for data analysis was the SPSS® (version, 21.0) using descriptive statistics, t-test, ANOVA, chi-square analyses, bivariate comparisons, and stepwise multiple logistic regression analysis. The results showed that birth weight, mother’s educational status, maternal occupation, living in a rural area, family size, number of children under five years of age in the household, cooking with charcoal, inhabiting wooden or straw housing or housing without proper floors, overall duration of breastfeeding as well as duration of exclusive breastfeeding, and time of initiation of complementary feeding were significantly related to stunting. Thus, appropriate nutritional intervention programmes considering these determinants and the dissemination of knowledge at the population level related to undernutrition are necessary to ameliorate the children´s nutritional status.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 91%

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Factors Associated with Stunting among Children Aged 0 to 59 Months from the Central Region of Mozambique

et al. 2017

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“…The findings are in accordance with those of previous smaller sample studies and in studies from other care settings. [63][64][65][66][67][68] The effect size for the distance variables in this study was small overall (close to 1) compared with those reported in the other studies, probably because we adjusted for more potentially confounding variables and the interference of the other important service variables.…”

Section: Main Findingscontrasting

confidence: 71%

“…Another possible approach to address the inequality associated with geographical accessibility is through the application of modern technologies; for example, telemedicine/health has been used in a palliative care setting and shows promise to improve access to care. [64][65][66]…”

Section: Discussionmentioning

confidence: 99%

The role of service factors on variations in place of death: an observational study

Gao

Chukwusa

Verne

et al. 2019

Health Serv Deliv Res

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Background Previous studies have revealed that there is significant geographical variation in place of death in (PoD) England, with sociodemographic and clinical characteristics explaining ≤ 25% of this variation. Service factors, mostly modifiable, may account for some of the unexplained variation, but their role had never been evaluated systematically. Methods A national population-based observational study in England, using National Death Registration Database (2014) linked to area-level service data from public domains, categorised by commissioning, type and capacity, location and workforce of the services, and the service use. The relationship between the service variables and PoD was evaluated using beta regression at the area level and using generalised linear mixed models at the patient level. The relative contribution of service factors at the area level was assessed using the per cent of variance explained, measured by R2. The total impact of service factors was evaluated by the area under the receiver operating characteristic curve (AUC). The independent effect of service variables was measured at the individual level by odds ratios (ORs). Results Among the 431,735 adult deaths, hospitals were the most common PoD (47.3%), followed by care homes (23.1%), homes (22.5%) and hospices (6.1%). One-third (30.3%) of the deaths were due to cancer and two-thirds (69.7%) were due to non-cancer causes. Almost all service categories studied were associated with some of the area-level variation in PoD. Service type and capacity had the strongest link among all service categories, explaining 14.2–73.8% of the variation; service location explained 10.8–34.1% of the variation. The contribution of other service categories to PoD was inconsistent. At the individual level, service variables appeared to be more useful in predicting death in hospice than in hospital or care home, with most AUCs in the fair performance range (0.603–0.691). The independent effect of service variables on PoD was small overall, but consistent. Distance to the nearest care facility was negatively associated with death in that facility. At the Clinical Commissioning Group level, the number of hospices per 10,000 adults was associated with a higher chance of hospice death in non-cancer causes (OR 30.88, 99% confidence interval 3.46 to 275.44), but a lower chance of hospice death in cancer causes. There was evidence for an interaction effect between the service variables and sociodemographic variables on PoD. Limitations This study was limited by data availability, particularly those specific to palliative and end-of-life care; therefore, the findings should be interpreted with caution. Data limitations were partly due to the lack of attention and investment in this area. Conclusion A link was found between service factors and PoD. Hospice capacity was associated with hospice death in non-cancer cases. Distance to the nearest care facility was negatively correlated with the probability of a patient dying there. Effect size of the service factors was overall small, but the interactive effect between service factors and sociodemographic variables suggests that high-quality end-of-life care needs to be built on service-level configuration tailored to individuals’ circumstances. Future work A large data gap was identified and data collection is required nationally on services relevant to palliative and end-of-life care. Future research is needed to verify the identified links between service factors and PoD. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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Philosophy, Questions and Methods in Health and Medical Geography in Africa

Adewoyin

2023

Global Perspectives on Health Geography

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Geographical accessibility to healthcare and malnutrition in Rwanda

Cited by 57 publications

References 32 publications

Factors Associated with Stunting among Children Aged 0 to 59 Months from the Central Region of Mozambique

Factors Associated with Stunting among Children Aged 0 to 59 Months from the Central Region of Mozambique

The role of service factors on variations in place of death: an observational study

Philosophy, Questions and Methods in Health and Medical Geography in Africa

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