IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v130y2015icp135-145.html
   My bibliography  Save this article

Geographical accessibility to healthcare and malnutrition in Rwanda

Author

Listed:
  • Aoun, Nael
  • Matsuda, Hirotaka
  • Sekiyama, Makiko

Abstract

The prevalence of stunting in children less than five years of age is elevated in Rwanda. It is one of the main health challenges upon which the government is struggling to achieve progress. Health centers and district hospitals in Rwanda are expected to provide a package of health services including nutrition related activities, nutritional rehabilitation, education, and growth monitoring. They can hence play a potent role in alleviating malnutrition and stunting in Rwanda. This study tested whether travel time from household clusters to the nearest health center was significantly and negatively associated with the distribution of height-for-age z-scores of younger than five year old children in the eastern province of Rwanda. Data for 974 children was extracted from the Rwanda Demographic and Health Survey (DHS) database. However, since DHS does not contain any information on travel time to health centers, the latter was simulated using AccessMod 4.0, an extension to ArcGIS 9.3.1 that simulates health facilities' catchment areas and travel times to health facilities. Travel time was found to be negatively associated with height-for-age z-scores at the 5% level in a stepwise regression analysis that controlled for wealth index, mother's primary and secondary education, sex of the child, preceding birth interval, and birth order of the child. Field measurements are needed to validate travel time. If validated, results point to the importance of improved access to healthcare facilities as a potential pathway in reducing stunting in Rwanda.

Suggested Citation

  • Aoun, Nael & Matsuda, Hirotaka & Sekiyama, Makiko, 2015. "Geographical accessibility to healthcare and malnutrition in Rwanda," Social Science & Medicine, Elsevier, vol. 130(C), pages 135-145.
    • Handle: RePEc:eee:socmed:v:130:y:2015:i:c:p:135-145
    DOI: 10.1016/j.socscimed.2015.02.004
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953615000878
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2015.02.004?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Horton, Susan, 1988. "Birth Order and Child Nutritional Status: Evidence from the Philippines," Economic Development and Cultural Change, University of Chicago Press, vol. 36(2), pages 341-354, January.
    2. Katsushi Imai & Per A. Eklund, 2008. "Women's Organizations and Social Capital to Reduce Prevalence of Child Malnutrition in Papua New Guinea," Oxford Development Studies, Taylor & Francis Journals, vol. 36(2), pages 209-233.
    3. Tanser, Frank & Gijsbertsen, Brice & Herbst, Kobus, 2006. "Modelling and understanding primary health care accessibility and utilization in rural South Africa: An exploration using a geographical information system," Social Science & Medicine, Elsevier, vol. 63(3), pages 691-705, August.
    4. Per Eklund & Katsushi Imai & Fabrizio Felloni, 2007. "Women's organisations, maternal knowledge, and social capital to reduce prevalence of stunted children: Evidence from rural Nepal," Journal of Development Studies, Taylor & Francis Journals, vol. 43(3), pages 456-489.
    5. World Bank, 2004. "Education in Rwanda : Rebalancing Resources to Accelerate Post-Conflict Development and Poverty Reduction," World Bank Publications - Books, The World Bank Group, number 15034.
    6. Engle, Patrice L. & Menon, Purnima & Haddad, Lawrence, 1999. "Care and Nutrition: Concepts and Measurement," World Development, Elsevier, vol. 27(8), pages 1309-1337, August.
    7. Masters, Samuel H. & Burstein, Roy & Amofah, George & Abaogye, Patrick & Kumar, Santosh & Hanlon, Michael, 2013. "Travel time to maternity care and its effect on utilization in rural Ghana: A multilevel analysis," Social Science & Medicine, Elsevier, vol. 93(C), pages 147-154.
    8. Haughton, Dominique & Haughton, Jonathan, 1997. "Explaining Child Nutrition in Vietnam," Economic Development and Cultural Change, University of Chicago Press, vol. 45(3), pages 541-556, April.
    9. Defo, Barthélémy Kuate, 1997. "Effects of socioeconomic disadvantage and women's status on women's health in Cameroon," Social Science & Medicine, Elsevier, vol. 44(7), pages 1023-1042, April.
    10. Stock, Robert, 1983. "Distance and the utilization of health facilities in rural Nigeria," Social Science & Medicine, Elsevier, vol. 17(9), pages 563-570, January.
    11. Mitsunaga, Tisha & Hedt-Gauthier, Bethany & Ngizwenayo, Elias & Farmer, Didi Bertrand & Karamaga, Adolphe & Drobac, Peter & Basinga, Paulin & Hirschhorn, Lisa & Ngabo, Fidele & Mugeni, Cathy, 2013. "Utilizing community health worker data for program management and evaluation: Systems for data quality assessments and baseline results from Rwanda," Social Science & Medicine, Elsevier, vol. 85(C), pages 87-92.
    12. Rosero-Bixby, Luis, 2004. "Spatial access to health care in Costa Rica and its equity: a GIS-based study," Social Science & Medicine, Elsevier, vol. 58(7), pages 1271-1284, April.
    13. Smith, Lisa C. & Ramakrishnan, Usha & Ndiaye, Aida & Haddad, Lawrence James & Martorell, Reynaldo, 2003. "The importance of women's status for child nutrition in developing countries:," Research reports 131, International Food Policy Research Institute (IFPRI).
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Janet Njelesani & Jenna Siegel & Emily Ullrich, 2018. "Realization of the rights of persons with disabilities in Rwanda," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-15, May.
    2. Thapa, Ganesh & Shively, Gerald, 2018. "A dose-response model of road development and child nutrition in Nepal," Research in Transportation Economics, Elsevier, vol. 70(C), pages 112-124.
    3. Chen, Qiulin & Xu, Duo & Fu, Hongqiao & Yip, Winnie, 2022. "Distance effects and home bias in patient choice on the Internet: Evidence from an online healthcare platform in China," China Economic Review, Elsevier, vol. 72(C).
    4. Samuel Manda & Ndamonaonghenda Haushona & Robert Bergquist, 2020. "A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa," IJERPH, MDPI, vol. 17(9), pages 1-20, April.
    5. Noah Kaiser & Christina K. Barstow, 2022. "Rural Transportation Infrastructure in Low- and Middle-Income Countries: A Review of Impacts, Implications, and Interventions," Sustainability, MDPI, vol. 14(4), pages 1-48, February.
    6. Kofinti, Raymond Elikplim & Koomson, Isaac & Paintsil, Jones Arkoh & Ameyaw, Edward Kwabena, 2022. "Reducing children's malnutrition by increasing mothers' health insurance coverage: A focus on stunting and underweight across 32 sub-Saharan African countries," Economic Modelling, Elsevier, vol. 117(C).
    7. Li, Chuanyao & Wang, Junren, 2022. "A hierarchical two-step floating catchment area analysis for high-tier hospital accessibility in an urban agglomeration region," Journal of Transport Geography, Elsevier, vol. 102(C).
    8. Páez, Antonio & Anjum, Zoha & Dickson-Anderson, Sarah E. & Schuster-Wallace, Corinne J. & Martín Ramos, Belén & Higgins, Christopher D., 2020. "Comparing distance, time, and metabolic energy cost functions for walking accessibility in infrastructure-poor regions," Journal of Transport Geography, Elsevier, vol. 82(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Yao, Jing & Murray, Alan T. & Agadjanian, Victor, 2013. "A geographical perspective on access to sexual and reproductive health care for women in rural Africa," Social Science & Medicine, Elsevier, vol. 96(C), pages 60-68.
    2. Finn McGuire & Noemi Kreif & Peter C. Smith, 2021. "The effect of distance on maternal institutional delivery choice: Evidence from Malawi," Health Economics, John Wiley & Sons, Ltd., vol. 30(9), pages 2144-2167, September.
    3. Rae Lesser Blumberg & Kara Dewhurst & Soham G. Sen, 2013. "Gender-inclusive Nutrition Activities in South Asia : Volume 2. Lessons from Global Experiences," World Bank Publications - Reports 15980, The World Bank Group.
    4. Jana, Arnab & Harata, Noboru, 2016. "Provisioning health care infrastructure in communities: Empirical evidences from West Bengal, India," Socio-Economic Planning Sciences, Elsevier, vol. 54(C), pages 37-46.
    5. Mengying Cui & David Levinson, 2020. "Primal and Dual Access," Working Papers 2022-01, University of Minnesota: Nexus Research Group.
    6. Páez, Antonio & Scott, Darren M. & Morency, Catherine, 2012. "Measuring accessibility: positive and normative implementations of various accessibility indicators," Journal of Transport Geography, Elsevier, vol. 25(C), pages 141-153.
    7. Sinha, Aakanksha & McRoy, Ruth G. & Berkman, Barbara & Sutherland, Melissa, 2017. "Drivers of change: Examining the effects of gender equality on child nutrition," Children and Youth Services Review, Elsevier, vol. 76(C), pages 203-212.
    8. Neutens, Tijs, 2015. "Accessibility, equity and health care: review and research directions for transport geographers," Journal of Transport Geography, Elsevier, vol. 43(C), pages 14-27.
    9. Richard Mussa, 2015. "Intrahousehold and Interhousehold Child Nutrition Inequality in Malawi," South African Journal of Economics, Economic Society of South Africa, vol. 83(1), pages 140-153, March.
    10. Malapit, Hazel Jean L. & Kadiyala, Suneetha & Quisumbing, Agnes R. & Cunningham, Kenda & Tyagi, Parul, 2013. "Women’s empowerment in agriculture, production diversity, and nutrition: Evidence from Nepal:," IFPRI discussion papers 1313, International Food Policy Research Institute (IFPRI).
    11. Haddad, Lawrence James & Peña, Christine & Nishida, Chizuru & Quisumbing, Agnes R. & Slack, Alison T., 1996. "Food security and nutrition implications of intrahousehold bias," FCND discussion papers 19, International Food Policy Research Institute (IFPRI).
    12. Nicholson, Charles F. & Mwangi, Lucy & Staal, Steven J. & Thornton, Philip K., 2003. "Dairy Cow Ownership and Child Nutritional Status in Kenya," 2003 Annual meeting, July 27-30, Montreal, Canada 22154, American Agricultural Economics Association (New Name 2008: Agricultural and Applied Economics Association).
    13. Snyman, Lourens & Coetzee, Serena, 2024. "Measuring geographic accessibility in data poor rural areas by augmenting the road network with a triangular irregular network – A case study in the O.R. Tambo District Municipality of the Eastern Cap," Journal of Transport Geography, Elsevier, vol. 115(C).
    14. Smith, Lisa C. & Ruel, Marie T. & Ndiaye, Aida, 2005. "Why Is Child Malnutrition Lower in Urban Than in Rural Areas? Evidence from 36 Developing Countries," World Development, Elsevier, vol. 33(8), pages 1285-1305, August.
    15. Irene Casas & Eric Delmelle & Alejandro Varela, 2010. "A Space-Time Approach to Diffusion of Health Service Provision Information," International Regional Science Review, , vol. 33(2), pages 134-156, April.
    16. Imai, Katsushi S. & Annim, Samuel Kobina & Kulkarni, Veena S. & Gaiha, Raghav, 2014. "Women’s Empowerment and Prevalence of Stunted and Underweight Children in Rural India," World Development, Elsevier, vol. 62(C), pages 88-105.
    17. Aiyegbajeje Femi Ola & Ajayi Dickson Dare, 2018. "Mobile Communications, physical distance and access to follow-up healthcare service in Lagos Metropolis," Bulletin of Geography. Socio-economic Series, Sciendo, vol. 42(42), pages 7-18, December.
    18. Komatsu, Hitomi & Malapit, Hazel Jean L. & Theis, Sophie, 2015. "How does women’s time in reproductive work and agriculture affect maternal and child nutrition? Evidence from Bangladesh, Cambodia, Ghana, Mozambique, and Nepal:," IFPRI discussion papers 1486, International Food Policy Research Institute (IFPRI).
    19. Wiesmann, Doris, 2006. "A global hunger index: measurement concept, ranking of countries, and trends," FCND discussion papers 212, International Food Policy Research Institute (IFPRI).
    20. Jemimah Micere Njuki & Amanda Wyatt & Isabelle Baltenweck & Kathryn Yount & Clair Null & Usha Ramakrishnan & Aimee Webb Girard & Shreyas Sreenath, 2016. "An Exploratory study of Dairying Intensification, Women’s Decision Making, and Time Use and Implications for Child Nutrition in Kenya," The European Journal of Development Research, Palgrave Macmillan;European Association of Development Research and Training Institutes (EADI), vol. 28(4), pages 722-740, September.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:130:y:2015:i:c:p:135-145. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.