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Proximity to healthcare clinic and depression risk in South Africa: geospatial evidence from a nationally representative longitudinal study

Abstract

Proximity to primary healthcare facilities may be a serious barrier to accessing mental health services in resource-limited settings. In this study, we examined whether the distance to the primary healthcare clinic (PHCC) was associated with risk of depression in KwaZulu-Natal Province, South Africa. Depressive symptoms and household coordinates data were accessed from the nationally representative South African National Income Dynamics Study. Distances between households and their nearest PHCCs were calculated and mixed-effects logistic regression models fitted to the data. Participants residing <6 km from a PHCC (aOR = 0.608, 95% CI 0.42–0.87) or 6–14.9 km (aOR = 0. 612, 95% CI 0.44–0.86) had a lower depression risk compared to those residing ≥15 km from the nearest PHCC. Distance to the PHCC was independently associated with increased depression risk, even after controlling for key socioeconomic determinants. Minimizing the distance to PHCC through mobile health clinics and technology could improve mental health.

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Acknowledgements

Waves 1–3 Data: Southern Africa Labour and Development Research Unit. National Income Dynamics Study. Cape Town: Southern Africa Labour and Development Research Unit (producer), 2015. Cape Town: DataFirst (distributor), 2015. We thank Lynn Woolfrey at DataFirst at the University of Cape Town. AT was supported by SA MRC Flagship Grant (MRC-RFAUFSP-01-2013/UKZN HIVEPI) and National Institutes of Health Research Training Grant (R25TW009337), funded by the Fogarty International Center and the National Institute of Mental Health. AV was supported by SA MRC Flagship Grant (MRC-RFAUFSP-01-2013/UKZN HIVEPI). FT was supported by South African MRC Flagship (MRC-RFA-UFSP-01-2013/UKZN HIVEPI) and NIH Grants (R01HD084233 and R01AI124389) as well as a UK Academy of Medical Sciences Newton Advanced Fellowship (NA150161). The study was also supported by University of KwaZulu-Natal funding to RS. The content is solely the responsibility of the authors and does not necessarily represent the official views of the SA MRC, UK Academy of Medical Sciences or the NIH. All authors declare that they have no conflicts of interest.

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Correspondence to Andrew Tomita.

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Tomita, A., Vandormael, A.M., Cuadros, D. et al. Proximity to healthcare clinic and depression risk in South Africa: geospatial evidence from a nationally representative longitudinal study. Soc Psychiatry Psychiatr Epidemiol 52, 1023–1030 (2017). https://doi.org/10.1007/s00127-017-1369-x

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Keywords

  • Primary healthcare clinic
  • Depression
  • Social disconnectedness
  • GPS
  • South Africa