Access to health care and mortality of children under 5 years of age in the Gambia: a case–control study
Merrin E Rutherford, John D Dockerty, Momodou Jasseh, Stephen RC Howie, Peter Herbison, David J Jeffries, Melissa Leach, Warren Stevens, Kim Mulholland, Richard A Adegbola & Philip C Hill
Volume 87, Number 3, March 2009, 216-224
Table 4. Association between primary caregiver financial indicators of access to health care and child death, FDSS, the Gambia
| Variable | Cases No. (%) | Controls No. (%) | Crude OR (95% CI) | Adjusted OR (95% CI) |
|---|---|---|---|---|
| Primary caregiver wealth | ||||
| Amount of income generated by primary caregiver, in dalasi | ||||
| 0 | 95 (67.9) | 383 (54.7) | 1.0 | 1.0 |
| 1–500 | 23 (16.4) | 115 (16.4) | 0.8 (0.5–1.3) | 1.0 (0.5–2.0)a |
| > 500 | 22 (15.7) | 202 (28.9) | 0.4 (0.3–0.7) | 0.6 (0.3–1.2)a |
| Received money from an outside source | ||||
| Yes | 53 (37.9) | 286 (40.9) | 1.0 | 1.0 |
| No | 87 (62.1) | 414 (59.1) | 1.1 (0.8–1.6) | 1.1 (0.8–1.6)* |
| Financial autonomy (95 cases and 383 controls had no income) | ||||
| Could decide how earned money was spent | ||||
| All | 41 (91.1) | 306 (96.5) | 1.0 | 1.0 |
| Some, a little, or none | 4 (8.9) | 11 (3.5) | 9.7 (1.0–92.5) | 12.7b (1.3–127.6)b |
| Used own money to pay for health care | ||||
| Yes | 12 (8.6) | 36 (5.1) | 1.0 | 1.0 |
| No | 128 (91.4) | 664 (94.9) | 0.6 (0.3–1.2) | 0.5 (0.2–1.0)c |
| Monetary sources used to cover health care costs (indicators of availability) | ||||
| Savings | ||||
| Yes | 72 (51.4) | 393 (56.1) | 1.0 | 1.0 |
| No | 68 (48.6) | 307 (43.9) | 1.2 (0.8–1.7) | 1.2 (0.8–1.7)* |
| Cutting back on spending | ||||
| Yes | 18 (12.9) | 186 (26.6) | 1.0 | 1.0 |
| No | 122 (87.1) | 514 (73.4) | 2.5 (1.5–4.2) | 2.5 (1.5–4.2)* |
| Selling goods of livestock | ||||
| Yes | 59 (42.1) | 233 (33.3) | 1.0 | 1.0 |
| No | 81 (57.9) | 467 (66.7) | 0.7 (0.5–1.0) | 0.9 (0.6–1.3)d |
| Monetary sources used to cover child death and health care costs (indicators of unavailability) | ||||
| Doing odd jobs | ||||
| No | 103 (73.6) | 640 (91.4) | 1.0 | 1.0 |
| Yes | 37 (26.4 | 60 (8.6) | 3.8 (2.4–6.2) | 3.4 (2.1–5.5)e |
| Borrowing from friends | ||||
| No | 133 (95.0) | 664 (94.9) | 1.0 | 1.0 |
| Yes | 7 (5.0) | 36 (5.1) | 1.0 (0.4–2.2) | 0.7 (0.3–1.7)f |
| Borrowing from lenders | ||||
| No | 137 (97.9) | 682 (97.4) | 1.0 | 1.0 |
| Yes | 3 (2.1) | 18 (2.6) | 0.8 (0.2–2.8) | 0.6 (0.2–2.2)g |
| Time availability | ||||
| Average amount of time spent working at any occupation, in hours | ||||
| 0–5 | 9 (6.4) | 109 (15.6) | 1.0 | 1.0 |
| 6–10 | 108 (77.1) | 511 (73.0) | 2.6 (1.3–5.3) | 2.9 (0.8–10.2)h |
| 11–15 | 23 (16.4) | 80 (11.4) | 3.6 (1.6–8.4) | 2.5 (0.6–10.1)h |
| Number of other children cared for by primary caregiver | ||||
| 0 | 14 (10.0) | 28 (4.0) | 1.0 | 1.0 |
| 1–3 | 90 (64.3) | 462 (66.0) | 0.4 (0.2–0.8) | 0.2 (0.1–0.5)i |
| ≥ 4 | 36 (25.7) | 210 (30.0) | 0.3 (0.2–0.7) | 0.2 (0.1–0.4)i |
FDSS, Farafenni demographic surveillance system; OR, odds ratio. * Association not altered beyond 10% following multivariate analysis.Factors controlled for in multivariate analysis:
a Allocated health centre, readily available money, vitamin A status, vaccination status, time spent working, rural residence;
b Primary caregiver educational level;
c Primary caregiver ethnicity, primary caregiver age, rural residence, time spent working, primary caregiver education level;
d Rural residence, allocated health centre;
e Rural residence;
f Rural residence, allocated health centre;
g Allocated health centre;
h Rural residence, allocated health centre, vaccination status, vitamin A status;
i Number of pregnancies of primary caregiver.