Spatial patterns of child mortality in Nanoro HDSS site, Burkina Faso

Background: Half of global child deaths occur in sub-Saharan Africa. Understanding child mortality patterns and risk factors will help inform interventions to reduce this heavy toll. The Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso was described previously, but spatial patterns of child mortality in the district had not been studied. Similar studies in other districts indicated accessibility to health facilities as a risk factor, usually without distinction between facility types. Methods: Using Nanoro HDSS data from 2009 to 2013, we estimated the association between under-5 mortality and accessibility to inpatient and outpatient health facilities, seasonality of death, and age group. Results: Living in homes 40-60 minutes and >60 minutes travel time from an inpatient facility was associated with 1.52 (95% CI: 1.13-2.06) and 1.74 (1.27-2.40) greater hazard of under-5 mortality, respectively, than living in homes <20 minutes from an inpatient facility. No such association was found for outpatient facilities. Seasonality of death was significantly associated with under-5 mortality, and the wet season (July-November) was associated with 1.28 (1.07, 1.53) higher under-5 mortality than the dry season (December-June), likely reflecting the malaria season. Conclusions: Our results emphasize the importance of geographical accessibility to health care, and also distinguish between inpatient and outpatient facilities.