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The effect of distance on observed mortality, childhood pneumonia and vaccine efficacy in rural Gambia

  • S. M. A. ZAMAN (a1), J. COX (a2), G. C. ENWERE (a1), C. BOTTOMLEY (a3), B. M. GREENWOOD (a2) and F. T. CUTTS (a1)...

We investigated whether straight-line distance from residential compounds to healthcare facilities influenced mortality, the incidence of pneumonia and vaccine efficacy against pneumonia in rural Gambia. Clinical surveillance for pneumonia was conducted on 6938 children living in the catchment areas of the two largest healthcare facilities. Deaths were monitored by three-monthly home visits. Children living >5 km from the two largest healthcare facilities had a 2·78 [95% confidence interval (CI) 1·74–4·43] times higher risk of all-cause mortality compared to children living within 2 km of these facilities. The observed rate of clinical and radiological pneumonia was lower in children living >5 km from these facilities compared to those living within 2 km [rate ratios 0·65 (95% CI 0·57–0·73) and 0·74 (95% CI 0·55–0·98), respectively]. There was no association between distance and estimated pneumococcal vaccine efficacy. Geographical access to healthcare services is an important determinant of survival and pneumonia in children in rural Gambia.

Corresponding author
*Author for correspondence: Dr S. M. A. Zaman, Child Survival Theme, Medical Research Council Unit, Atlantic Road, Fajara, P.O. Box 273 Banjul, The Gambia. (Email:
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2. J Van den Broeck , R Eeckels , G Massa . Maternal determinants of child survival in a rural African community. International Journal of Epidemiology 1996; 25: 9981004.

4. Schellenberg JR Armstrong , Health and survival of young children in southern Tanzania. BMC Public Health 2008; 8: 194.

5. D Kadobera , The effect of distance to formal health facility on childhood mortality in rural Tanzania, 2005–2007. Global Health Action 2012; 5: 19.

6. LN Kazembe , I Kleinschmidt , BL Sharp . Patterns of malaria-related hospital admissions and mortality among Malawian children: an example of spatial modelling of hospital register data. Malaria Journal 2006; 5: 93.

8. MM Rahaman , diarrhea clinic in rural Bangladesh: influence of distance, age, and sex on attendance and diarrheal mortality. American Journal of Public Health 1982; 72: 11241128.

10. JI Blanford , It's a long, long walk: accessibility to hospitals, maternity and integrated health centers in Niger. International Journal of Health Geographics 2012; 11: 24.

13. FT Cutts , Efficacy of nine-valent pneumococcal conjugate vaccine against pneumonia and invasive pneumococcal disease in The Gambia: randomised, double-blind, placebo-controlled trial. Lancet 2005; 365: 11391146.

14. J Hansen , Effectiveness of heptavalent pneumococcal conjugate vaccine in children younger than 5 years of age for prevention of pneumonia: updated analysis using World Health Organization standardized interpretation of chest radiographs. Pediatric Infectious Disease Journal 2006; 25: 779781.

15. KP Klugman , A trial of a 9-valent pneumococcal conjugate vaccine in children with and those without HIV infection. New England Journal of Medicine 2003; 349: 13411348.

17. TJ O'Dempsey , Overlap in the clinical features of pneumonia and malaria in African children. Transactions of the Royal Society of Tropical Medicine and Hygiene 1993; 87: 662665.

18. A Al-Taiar , Physical accessibility and utilization of health services in Yemen. International Journal of Health Geographics 2010; 9: 38.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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