Meningitis and unpaved roads.

Access to health care may be influenced by a variety of factors including ones attributable to the individual as well as ones attributable to the health care system. One category frequently referred to is 'geographic' factors of distance and travel time. In the present study, a previously undescribed geographic factor--unpaved roads--is shown to be a clinically important barrier to access. Using a case-control format, children admitted with bacterial meningitis are shown to have traveled farther over unpaved roads to get to a clinic than matched controls seen at the same time. With control groups matched for age and similar pre-existing illness, the implication is that unpaved roads resulted in increased morbidity by reducing access.