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Trop Med Int Health. 2011 Jun;16(6):711-20. doi: 10.1111/j.1365-3156.2011.02752.x. Epub 2011 Mar 29.

Impact of implementation of free high-quality health care on health facility attendance by sick children in rural western Kenya.

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  • 1Rollins School of Public Health, Emory University, Atlanta, GA, USA.



To explore whether implementation of free high-quality care as part of research programmes resulted in greater health facility attendance by sick children.


As part of the Intermittent Preventive Treatment for Malaria in Infants (IPTi), begun in 2004, and population-based infectious disease surveillance (PBIDS), begun in 2005 in Asembo, rural western Kenya, free high-quality care was offered to infants and persons of all ages, respectively, at one Asembo facility, Lwak Hospital. We compared rates of sick-child visits by children <10 years to all seven Asembo clinics before and after implementation of free high-quality care in 10 intervention villages closest to Lwak Hospital and 8 nearby comparison villages not participating in the studies. Incidence rates and rate ratios for sick-child visits were compared between intervention and comparison villages by time period using Poisson regression.


After IPTi began, the rate of sick-child visits for infants, the study's target group, in intervention villages increased by 191% (95% CI 75-384) more than in comparison villages, but did not increase significantly more in older children. After PBIDS began, the rate of sick-child visits in intervention villages increased by 267% (95% CI 76-661) more than that in comparison villages for all children <10 years. The greatest increases in visit rates in intervention villages occurred 3-6 months after the intervention started. Visits for cough showed greater increases than visits for fever or diarrhoea.


Implementation of free high-quality care increased healthcare use by sick children. Cost and quality of care are potentially modifiable barriers to improving access to care in rural Africa.

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