Globally, fifty percent of deaths in children occur in sub-Saharan Africa. If the current trend persists, Sub-Saharan Africa will not reach Millennium Development Goal 4 (reduce child mortality by two thirds) until 2165, 150 years after the target date. Treatable or preventable infectious diseases such as pneumonia, malaria, and diarrhea, account for 61% of childhood deaths after the neonatal period. Therefore, a large proportion of deaths from birth to the fifth birthday are attributable to a handful of common causes that are avoidable through existing interventions, many of which are delivered through health facilities. It seems probable that access to these life-saving interventions is limited by the health systems that deliver them. The objective of the proposed work is to use innovative spatial techniques to quantify the contribution of access to health services in reducing childhood morbidity and mortality. We will use large, existing datasets to describe the relationship between health outcomes and geographic distribution of health services at different spatial scales. Ultimately, the goal of such an approach is to provide evidence regarding the impact of health systems infrastructure on disease burden, independent of disease-specific interventions. The impact of health systems is difficult to measure and large comparison studies or randomized trials are often not feasible. However, applying spatial statistical techniques to this problem can provide evidence for causal relationships in the absence of a counterfactual.
Approximately 61% of child mortality after the neonatal period worldwide can be attributed to three infectious diseases - pneumonia, diarrhea and malaria, which can all be treated or prevented through routine contact with basic health services. Inadequate and inequitable access to health services has an impact on the burden of these diseases. The central question of this proposal is: how does the variability in geographic access to health services impact 1) effective prevention, 2) effective treatment, and 3) changes in the burden of disease?
| Nkumama, Irene N; O'Meara, Wendy P; Osier, Faith H A (2017) Changes in Malaria Epidemiology in Africa and New Challenges for Elimination. Trends Parasitol 33:128-140 |
| Anthopolos, Rebecca; Simmons, Ryan; O'Meara, Wendy Prudhomme (2017) A retrospective cohort study to quantify the contribution of health systems to child survival in Kenya: 1996-2014. Sci Rep 7:44309 |
