Modelling and understanding primary health care accessibility and utilization in rural South Africa: An exploration using a geographical information system
Modelling and understanding primary health care accessibility and utilization in rural South Africa: An exploration using a geographical information system
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DOI：
10.1016/j.socscimed.2006.01.015
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发表时间：
2006-08-01
影响因子：
5.4
通讯作者：
Herbst, Kobus
中科院分区：
文献类型：
--
作者：
Tanser, Frank;Gijsbertsen, Brice;Herbst, Kobus
获得医疗保健的实际机会影响到一大批健康结果。然而，在许多发展中国家，在传统地理技术往往不适用的情况下，要有意义地估计实际可获得性仍然是难以实现的。我们就夸祖鲁-纳塔尔HLabisa健康小区的诊所使用情况采访了(并按地理位置定位)23.000个宅基地。南非。我们使用地理信息系统中的成本分析来估计(在任何给定位置)到诊所的平均旅行时间，并得出诊所的覆盖范围。该模型考虑了可能使用公共交通的人的比例(作为估计步行到诊所的时间的函数)、公路网和自然屏障的质量和分布，并使用报告的旅行时间进行了校准。我们使用该模型调查了农村、城市和城市周边地区宅基地对诊所使用的差异，并量化了实际进入诊所对使用的影响。我们能够预测报告的临床使用情况，准确率为91%。前往就近诊所的平均旅行时间为81分钟，65%的宅基地前往就近诊所的时间在1小时或更长时间。随着旅行时间的增加，物流使用量显著下降(p<；0.0001)。诊所使用诊所后30分钟内拥有宅基地的调整几率是90-120分钟区域内宅基地的10倍(调整后OR=10：95，CI 6.9-14.4)。城市宅基地使用诊所的调整几率大约比农村/城市周边的诊所小20/30倍。分别进行了分析。在控制了到临床旅行时间的系统性差异后。估计前往地区医院的旅行时间中位数为170分钟。这一方法构成了一个框架，用于模拟许多发展中国家的诊所实际使用情况。(C)2006爱思唯尔有限公司。保留所有权利。
Physical access to health care affects a large array of health outcomes. yet meaningfully estimating physical access remains elusive in many developing country contexts where conventional geographical techniques are often not appropriate. We interviewed (and geographically positioned) 23.000 homesteads regarding clinic usage in the Hlabisa health sub-district, KwaZulu-Natal. South Africa. We used a cost analysis within a geographical information system to estimate mean travel time (at any given location) to clinic and to derive the clinic catchments. The model takes into account the proportion of people likely to be using public transport (as a function of estimated walking time to clinic), the quality and distribution of the road network and natural barriers, and was calibrated using reported travel times. We used the model to investigate differences in rural, urban and peri-urban usage of clinics by homesteads in the study area and to quantify the effect of physical access to clinic on usage. We were able to predict the reported clinic used with an accuracy of 91%. The median travel time to nearest clinic is 81 min and 65% of homesteads travel I h or more to attend the nearest clinic. There was a significant logistic decline in usage with increasing travel time (p < 0.0001). The adjusted odds of a homestead within 30 min of a clinic making use of the clinics were 10 times (adjusted OR = 10: 95 CI 6.9-14.4) those of a homestead in the 90-120 min zone. The adjusted odds Of Usage of the clinics by urban homesteads were approximately 20/30 times smaller than those of their rural/peri-urban Counterparts. respectively. after controlling for systematic differences in travel time to clinic. The estimated median travel time to the district hospital is 170 min. The methodology constitutes a framework for modelling physical access to clinics in many developing country settings. (c) 2006 Elsevier Ltd. All rights reserved.