How access to health care relates to under-five mortality in sub-Saharan Africa: systematic review

Trop Med Int Health. 2010 May;15(5):508-19. doi: 10.1111/j.1365-3156.2010.02497.x. Epub 2010 Mar 15.


An estimated 9.7 million children under the age of five die every year worldwide, approximately 41% of them in sub-Saharan Africa (SSA). Access to adequate health care is among the factors suggested to be associated with child mortality; improved access holds great potential for a significant reduction in under-five death in developing countries. Theory and corresponding frameworks indicate a wide range of factors affecting access to health care, such as traditionally measured variables (distance to a health provider and cost of obtaining health care) and additional variables (social support, time availability and caregiver autonomy). Few analytical studies of traditional variables have been conducted in SSA, and they have significant limitations and inconclusive results. The importance of additional factors has been suggested by qualitative and recent quantitative studies. We propose that access to health care is multidimensional; factors other than distance and cost need to be considered by those planning health care provision if child mortality rates are to be reduced through improved access. Analytical studies that comprehensively evaluate both traditional and additional variables in developing countries are required.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Africa South of the Sahara
  • Cause of Death
  • Child Mortality*
  • Child, Preschool
  • Developing Countries
  • Female
  • Health Care Costs
  • Health Services Accessibility / economics*
  • Health Services Accessibility / statistics & numerical data
  • Humans
  • Infant
  • Infant Mortality*
  • Male
  • Personal Autonomy
  • Pregnancy
  • Sex Factors
  • Socioeconomic Factors