THE EFFECT OF DISTANCE FROM HOME ON ATTENDANCE AT A SMALL RURAL HEALTH-CENTER IN PAPUA-NEW-GUINEA

Backgound The willingness of patients in the rural tropics to seek med ical fare at primary health care facilities is influenced by the dista nce they have to travel, but few studies have tried to estimate these distance effects. Methods Distance decay effects in attendance rates w ere estimated from a database of 4348 attendances at a rural health ce ntre in Papua New Guinea, linked to demographic and house position dat a for the catchment population. Small-scale spatial patterns and diffe rences between diagnoses, age groups and gender are described. Results Attendance decreased markedly with distance both overall (50% decreas e at 3.5 km) and for patients with malaria or acute respiratory infect ions. This decrease was non-linear (on log scale) with distance. Altho ugh constant over time, there were big differences in this distance ef fect among age and gender groups: Female patients showed less distance decay in adolescents and adults, bur higher in the infant group. Spat ial patterns accounted for 32% of the variation in age- and gender-spe cific attendance rates. Of the spatial effects more than 50% were due to distance effects. Conclusions Distance effects were similar in magn itude to those reported elsewhere, suggesting that distance effects ma y be generalizable to many parts of the rural tropics. The non-lineari ty of distance decay implies that a bell-shaped demand function should be used in health planning.