# Contributory factors to reporting distance as a barrier to health facility visit among reproductive-age Senegalese women: A survival analysis

## TL;DR

This study finds that distance is a major barrier for Senegalese women in accessing healthcare, especially in rural areas.

## Contribution

The study uses survival analysis to identify factors contributing to distance as a barrier to health facility visits in Senegal.

## Key findings

- 35.8% of women reported distance as a barrier to reaching a health facility.
- Rural women had a 36% higher risk of reporting distance as a barrier compared to urban women.
- Women from certain ethnic groups and regions had a lower risk of reporting distance as a barrier.

## Abstract

The burden of distance to healthcare facility is a factor of maternal morbidity and mortality in resource-constrained settings. In Senegal, little is known about distance or travel time as a barrier to health facility visit. The objective of this study was to assess distance as a barrier in reaching a health facility and its contributory factors among Senegalese women.

The data from 2023 Senegal Demographic and Health Survey (SDHS) was used in this study. A total sample of 16,583 women aged 15–49 years was analysed. Kaplan-Meier plot was used to estimate the median time to healthcare facilities. Furthermore, the factors of distance as a barrier in reaching a health facility were examined using multivariable Cox regression and reported as adjusted hazard ratio (aHR) with its 95% confidence intervals (CI). The statistical significance was determined at p < 0.05.

Overall, 35.8% of women reported distance as a barrier to reaching a health facility. The median time to a health facility was 13 minutes. Approximately two-thirds of the women reported walking to the nearest healthcare facility (66.4%), while others used animal-drawn cart (12.5%), motorcycle/scooter (9.3%) and car/truck (7.8%) respectively. Poular, Serer and Mandingue women had 10% (aHR= 0.90; 95% CI: 0.84–0.98), 19% (aHR= 0.81; 95% CI: 0.74–0.90) and 14% (aHR= 0.86; 95% CI: 0.76–0.97) reduction in the risk of reporting distance as a barrier in reaching a health facility, when compared with Wolof women. In addition, women from Dakar, Ziguinchor, Saint-Louis, Tambacounda, Kaolack, Thiès, Louga, Fatick, Kolda, Matam, Kaffrine, Kedougou and Sedhiou had higher risk of reporting distance as a barrier in reaching a health facility, when compared with women from Diourbel region. Rural women had 36% higher risk of reporting distance as a barrier in reaching a health facility (aHR= 1.36; 95% CI: 1.27–1.44), when compared with their urban counterparts.

Based on the findings of this study, rural and remote women have distance as a barrier to health facility visit. The travel time to a health facility is a critical indicator of the burden of distance to health facility and can therefore better inform health services planning for people residing in rural and remote locations in Senegal.