Geographical accessibility to public healthcare facilities and undernutrition in children under-5 in Uganda: a cross-sectional spatial analysis

In Uganda, 29% of all children under-5 experience some form of undernutrition, a key predictor of health outcomes. Healthcare accessibility is a key determinant of undernutrition. Longer travel times to healthcare may increase undernutrition due to access barriers. The aim of this study is to assess the impact of geographical accessibility on undernutrition in children under-5 in Uganda. The Ugandan Demographic Health Survey from 2016 (UDHS-2016) was used in combination with the AccessMod tool to estimate the travel time by walking to the nearest public healthcare facility. Travel time costs depend on distance, elevation, landcover, and road data. Three multivariate linear regression models were created for stunting (height-for-age Z-scores), wasting (weight-for-height Z-scores) and underweight (weight-for-age Z-scores) while accounting for covariates like parental- and child sociodemographic- & health factors. The study included 4,287 children with a mean travel time of 93 minutes (median: 77 min.). Urban clusters must travel significantly less than rural clusters. Travel times ranged from 12 min. (Kampala) to 142 min. (Acholi). All three regression models estimated no statistically significant association between travel time and either stunting, wasting, or underweight (p > 0.05). More research is required to understand the association between healthcare accessibility and undernutrition.