Distance to HIV and Antenatal Care: A Geospatial Analysis in Siaya County, Kenya.
Pamela K Kohler, Adam Akullian, John Okanda and 5 others
PMID 30694879WHAT IT FOUND
Distance to the nearest antenatal clinic was not associated with whether women attended antenatal care.
For delivery, every additional kilometre from the nearest facility was linked with a 7% lower chance of facility delivery. Travel distance did not differ by HIV status.
Key findings
01Distance to the nearest antenatal care clinic was not significantly associated with whether women accessed antenatal care.
02For each additional kilometre from the nearest delivery facility, the probability of facility delivery declined by 7%.
03Travel distance for antenatal care and delivery did not differ by HIV status.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The surveys were cross-sectional, so they show association at one time, not that distance caused lower facility delivery. HIV status was self-reported because fieldworkers were blinded to status, so misclassification may affect the HIV comparisons. The analysis used data from women who delivered in 2010 and facilities surveyed in 2011, before Option B+ PMTCT policies, so current service patterns may differ. Some women attended facilities outside the survey area, and GPS coordinates for those outside locations came from online sources, so distance to the facility actually attended may be less accurate. The study adjusted for age, education, stigma, and HIV status, but other social factors that influence care uptake were not measured. Facility-level service data came from the manager or nurse providing most antenatal HIV services, which may not capture all services offered.
Declared interests
All authors reported no financial interests or potential conflicts of interest.
The easy way to misread this
Do not conclude that distance is a barrier to antenatal care. In this study, distance to the nearest antenatal clinic was not significantly associated with antenatal care uptake. The distance association was for facility delivery.