Person:

Kentoffio, Katherine

Background: This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa. Methods: Cluster–sample survey data collected in 2012 in a very rural southeastern Liberian population were analyzed to determine associations between quartiles of GPS–measured distance from the nearest health facility and the odds of maternal (ANC, facility–based delivery, and PNC) and child (deworming and care seeking for ARI, diarrhea, and fever) service use. We estimated associations by fitting simple and multiple logistic regression models, with standard errors adjusted for clustered data. Findings: Living in the farthest quartile was associated with lower odds of attending 1–or–more ANC checkup (AOR = 0.04, P < 0.001), 4–or–more ANC checkups (AOR = 0.13, P < 0.001), delivering in a facility (AOR = 0.41, P = 0.006), and postnatal care from a health care worker (AOR = 0.44, P = 0.009). Children living in all other quartiles had lower odds of seeking facility–based fever care (AOR for fourth quartile = 0.06, P < 0.001) than those in the nearest quartile. Children in the fourth quartile were less likely to receive deworming treatment (AOR = 0.16, P < 0.001) and less likely (but with only marginal statistical significance) to seek ARI care from a formal HCW (AOR = 0.05, P = 0.05). Parents in distant quartiles more often sought ARI and diarrhea care from informal providers. Conclusions: Within a rural Liberian population, distance is associated with reduced health care uptake. As Liberia rebuilds its health system after Ebola, overcoming geographic disparities, including through further dissemination of providers and greater use of community health workers should be prioritized.

Background: Despite a growing global emphasis on universal healthcare, access to basic primary care for remote populations in post-conflict countries remains a challenge. To better understand health sector recovery in post-conflict Liberia, this paper seeks to evaluate changes in utilization of health services among rural populations across a 5-year time span. Methods: We assessed trends in healthcare utilization among the national rural population using the Liberian Demographic and Health Survey (DHS) from 2007 and 2013. We compared these results to results obtained from a two-staged cluster survey in 2012 in the district of Konobo, Liberia, to assess for differential health utilization in an isolated, remote region. Our primary outcomes of interest were maternal and child health service care seeking and utilization. Results: Most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013. However, this progress was not reflected in the remote Konobo population. A lower proportion of women received 4+ antenatal care visits (AOR 0.28, P < 0.001) or any postnatal care (AOR 0.25, P <0.001) in Konobo as compared to the 2013 DHS. Similarly, a lower proportion of children received professional care for common childhood illnesses, including acute respiratory infection (9 % vs. 52 %, P < 0.001) or diarrhea (11 % vs. 46 %, P < 0.001). Conclusions: Our data suggest that, despite the demonstrable success of post-war rehabilitation in rural regions, particularly remote populations in Liberia remain at disproportionate risk for limited access to basic health services. As a renewed effort is placed on health systems reconstruction in the wake of the Ebola-epidemic, a specific focus on solutions to reach isolated populations will be necessary in order to ensure extension of coverage to remote regions such as Konobo. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1709-7) contains supplementary material, which is available to authorized users.

Background: The weak health network in post-war Liberia is likely a primary contributor to the unprecedented 2014 Ebola outbreak in West Africa. This paper seeks to assess gaps in the health system prior to the epidemic by evaluating changes in access to maternal and child health services in a remote region compared to rural averages from 2007-2013.

Methods: We conducted a two-staged cluster survey in 2012 in the remote district of Konobo, Liberia. Our primary outcomes of interest were access to prenatal, peri-natal and postnatal care, and access to sick child services. We compared results from our survey to the rural sub-samples from the Demographic and Health Survey (DHS) in 2007 and 2013 to assess for differential service utilization in remote regions.

Results: Although most child and maternal health indicators improved in the DHS rural sub-sample from 2007 to 2013, this progress was not reflected in the remote Konobo population. Fewer women received 4+ antenatal care visits (OR 0.28, P< 0.001) and any postnatal care (OR 0.25, P<0.001) in Konobo as compared to the 2013 DHS. Similarly, fewer children received professional care for common childhood illnesses, including acute respiratory infection (9% vs 52%, P<0.001) and diarrhea (11% vs. 46%, P< 0.001).

Conclusions: Even before the Ebola epidemic, residents in remote areas of Liberia had severely limited access to basic services. Most indicators remain below 2013 levels, despite the overall progress seen elsewhere in rural Liberia from 2007-2013. As attention turns to rebuilding the healthcare infrastructure in Liberia, a specific focus on remote areas will be crucial.