The impact of primary health care on malaria morbidity--defining access by disease burden

Abstract

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.

Figure 1

Map showing Kilifi district and the study area under demographic surveillance. Kilifi district hospital, government-owned primary care facilities and walking times to the nearest primary care center are shown.

Figure 2

Incidence of hospitalized malaria (slide-positive) in children under five as a function of travel time to the nearest primary care facility. Dashed lines are 95% confidence intervals.

Figure 3

Incidence of slide-positive (solid line) and slide-negative (line with open circles) hospital admissions amongst children under five as a function of travel time to the nearest primary care facility. Dashed lines are 95% confidence intervals.