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Free Content The impact of primary health care on malaria morbidity – defining access by disease burden

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Abstract:

Summary 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.

French
Objectifs: 

Investiguer l’impact de la durée du voyage vers les soins primaires sur l’incidence des épisodes des cas de malaria hospitalisés dans un district rural du Kenya. Méthodes: 

L’incidence des cas de malaria hospitalisés dans une population sous surveillance démographique continue a été enregistrée sur plus de trois ans. Le temps pour atteindre le service de soins de santé primaire le plus proche a été calculé pour chaque enfant de la naissance à l’âge de cinq ans et les tendances de l’incidence des cas de malaria hospitalisés en fonction de la durée du voyage ont étéévalués. Résultats: 

L’incidence des cas de malaria hospitalisés a plus que doublé lorsque le temps pour atteindre le service de soins primaires le plus proche est passé de 10 minutes à 2 heures. Un meilleur accès aux services de soins de santé primaire pourrait réduire la charge de la maladie de plus de 66%. Conclusions: 

Nos résultats soulignent à la fois la capacité du système de soins de santé primaires à atteindre les personnes les plus à risque et à réduire la charge de la maladie. L’accès insuffisant est un facteur de risque important, inéquitablement réparti parmi les ménages les plus pauvres.

Keywords: Kenia; Kenya; acceso; access; accès; cuidados de atención primaria; durée du voyage; malaria morbidity; menores de cinco años; moins de cinq ans; morbidité de la malaria; morbilidad de malaria; primary health care; soins de santé primaires; tiempo de viaje; travel time

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-3156.2008.02194.x

Affiliations: 1:  Fogarty International Center, National Institutes of Health, Bethesda, MD, USA 2:  KEMRI/Wellcome Trust Collaborative Program, Nairobi, Kenya 3:  Kenya Medical Research Institute, CGMRC/Wellcome Trust Collaborative Program, Kilifi, Kenya 4:  Ministry of Health, Kilifi, Kenya

Publication date: January 1, 2009

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