A Beattie, J Wells, F Siroma, M Ba, A E Cabo, A B Traore, Y Gnokane, A Devort, A Vargas, D S N'Diaye, O Cumming, L Braun
Longer travel times were significantly associated with defaulting treatment. Nearly one in five children lived more than 2 h from care. Improving geographic access could enhance treatment completion and outcomes within CMAM programmes.
BACKGROUND: Severe Acute Malnutrition (SAM) remains a major public health issue for children under five in Senegal, particularly in rural areas. Community-based management of acute malnutrition (CMAM) has expanded access to treatment, yet distance to health centres may hinder adherence and lead to defaulting treatment, referred to as 'abandonment' in Senegal. We used data from the Traitement Intégré de la Sous-Nutrition Aiguë (TISA) trial in northern Senegal to assess whether travel time from households to health centres was associated with outpatient treatment adherence and defaulting.
METHODS: We combined GPS coordinates of participants' households and health centres with remotely sensed spatial data, such as road networks and landcover, to model travel times. Additional covariates, including rainfall, temperature, and a wealth index, were included in logistic regression and random-effects models to evaluate associations with treatment defaulting.
RESULTS: Among 1165 children included, 562 (48.2%) missed more than three of eight scheduled health centre visits and 353 (30.3%) defaulted treatment. The average modelled travel time to health centres was 57.7 min, and 16.2% lived more than 2 h away. After adjustment, each additional hour of travel time was associated with 1.20-fold higher odds of defaulting (95% CI 1.03-1.40). The highest category of cumulative rainfall (>90 mm) was associated with higher odds of defaulting (odds ratio [OR] 1.53, 95% CI 1.04-2.24), whereas the highest category of maximum temperature (>38°C) was not significantly associated with defaulting (OR 1.39, 95% CI 0.98-1.96.
CONCLUSIONS: Longer travel times were significantly associated with defaulting treatment. Nearly one in five children lived more than 2 h from care. Improving geographic access could enhance treatment completion and outcomes within CMAM programmes.