Exploring country-wide equitable government health care facility access in Uganda.
Exploring country-wide equitable government health care facility access in Uganda.
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DOI：
10.1186/s12939-020-01371-5
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发表时间：
2021-01-18
影响因子：
4.8
通讯作者：
Dowhaniuk N
中科院分区：
文献类型：
--
作者：
Dowhaniuk N
由于城市偏见、健康的社会决定因素以及与交通有关的障碍，撒哈拉以南非洲的农村获得保健仍然是一个挑战。撒哈拉以南非洲地区的卫生系统往往缺乏公平性，使最贫困居民获得最高医疗保健需求的医疗中心服务的机会不成比例地减少。随着撒哈拉以南非洲国家进入传染性和非传染性疾病负担同时高企的时期，缺乏卫生保健公平性已成为日益令人关切的问题，其中第二种疾病由于长期持续的护理而需要一个强大的初级保健网络。已经提出并推广自行车所有权，作为减少穷人获得保健服务的旅行障碍的一种工具。进行了可访问性分析，以确定乌干达人在一个小时的旅行时间内使用步行，骑自行车和驾驶的情况下到政府卫生中心的比例。使用空间统计学计算了前往卫生中心的高和低旅行时间的统计学显着集群。随机森林分析被用来探索贫困，人口密度，医疗中心的访问分钟，和使用自行车而不是步行前往医疗中心节省的时间之间的关系。然后使用线性混合效应模型来验证随机森林模型的性能。乌干达人在最近的第二卫生中心一小时步行距离内的比例为71.73%，通过自行车增加到90.57%。自行车将最近的三级卫生院1小时通达率从53.05%提高到80.57%，将分级综合国家实验室体系通达率提高了27.52个百分点。低卫生中心访问的显着集群与高度贫困和城市化的地区。在各级保健中心，到保健中心的旅行时间与贫穷之间存在着密切的直接关系。城市和农村人口之间存在着巨大的差距，与较富裕的城市居民相比，农村贫困居民前往保健中心的旅行时间过长。这项研究的结果强调了最脆弱的乌干达人，谁是最不可能负担得起的交通，经验最高的禁止旅行距离到卫生中心。自行车似乎是一种“有利于穷人”的工具，可以增加医疗服务的公平性。在线版本包含补充材料，可通过10.1186/s12939-020-01371-5获得。
Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor. An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking, bicycling, and driving scenarios. Statistically significant clusters of high and low travel time to health centers were calculated using spatial statistics. Random Forest analysis was used to explore the relationship between poverty, population density, health center access in minutes, and time saved in travel to health centers using a bicycle instead of walking. Linear Mixed-Effects Models were then used to validate the performance of the random forest models. The percentage of Ugandans within a one-hour walking distance of the nearest health center II is 71.73%, increasing to 90.57% through bicycles. Bicycles increased one-hour access to the nearest health center III from 53.05 to 80.57%, increasing access to the tiered integrated national laboratory system by 27.52 percentage points. Significant clusters of low health center access were associated with areas of high poverty and urbanicity. A strong direct relationship between travel time to health center and poverty exists at all health center levels. Strong disparities between urban and rural populations exist, with rural poor residents facing disproportionately long travel time to health center compared to wealthier urban residents. The results of this study highlight how the most vulnerable Ugandans, who are the least likely to afford transportation, experience the highest prohibitive travel distances to health centers. Bicycles appear to be a “pro-poor” tool to increase health access equity. The online version contains supplementary material available at 10.1186/s12939-020-01371-5.
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DOI：
10.1198/106186006x133933
发表时间：
2006-09-01
影响因子：
2.4
作者：
Hothorn, Torsten;Hornik, Kurt;Zeileis, Achim
通讯作者：
Zeileis, Achim
影响因子：
3.2
作者：
Allen, Elizabeth Palchik;Muhwezi, Wilson Winstons;Mbonye, Anthony Kabanza
通讯作者：
Mbonye, Anthony Kabanza
影响因子：
4.8
作者：
Bakeera, Solome K.;Wamala, Sarah P.;Pariyo, George W.
通讯作者：
Pariyo, George W.
影响因子：
2.6
作者：
Allen, Luke Nelson
通讯作者：
Allen, Luke Nelson
影响因子：
3.3
作者：
Hooft, Anneka;Nabukalu, Doreen;Sundararajan, Radhika
通讯作者：
Sundararajan, Radhika