Modelling distances travelled to government health services in Kenya
Modelling distances travelled to government health services in Kenya
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DOI：
10.1111/j.1365-3156.2005.01555.x
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发表时间：
2006-02-01
影响因子：
3.3
通讯作者：
Snow, RW
中科院分区：
文献类型：
--
作者：
Noor, AM;Amin, AA;Snow, RW
目的 作为千年发展目标中减轻艾滋病毒/艾滋病、结核病和疟疾负担的一部分，系统地评估获得医疗救治的空间可达性的描述性指标。
方法 我们获取了肯尼亚四个地区关于卫生服务、人口、交通网络、地形、土地覆盖和儿童发热治疗的高分辨率空间和流行病学数据，以建立肯尼亚政府卫生服务的可达性和使用模型。社区调查数据被用于建立发热儿童使用政府卫生服务的模型。然后实施了一个基于交通网络的模型，并根据实际使用模式进行了调整。我们将这个改进后的模型与欧几里得距离度量的预测准确性进行了比较。
结果 较高级别的设施对患者更具吸引力（在三种情况下分别为54%、58%和60%），高于较低级别的设施。根据设施间竞争情况进行调整的交通网络模型最为准确，并被选为最佳拟合模型。该模型估计研究地区63%的人口在1小时的国家可达性基准范围内，而欧几里得模型估计为82%。
结论 将研究地区最佳拟合模型的结果外推到全国水平表明，目前约有600万人被错误地估计在1小时内能够获得政府卫生服务。简单的欧几里得距离假设是需求评估的基础，也是评估千年发展目标的依据，因此需要重新考虑。
Objective To systematically evaluate descriptive measures of spatial access to medical treatment, as part of the millennium development goals to reduce the burden of HIV/AIDS, tuberculosis and malaria.Methods We obtained high-resolution spatial and epidemiological data on health services, population, transport network, topography, land cover and paediatric fever treatment in four Kenyan districts to develop access and use models for government health services in Kenya. Community survey data were used to model use of government health services by febrile children. A model based on the transport network was then implemented and adjusted for actual use patterns. We compared the predictive accuracy of this refined model to that of Euclidean distance metrics.Results Higher-order facilities were more attractive to patients (54%, 58% and 60% in three scenarios) than lower-order ones. The transport network model, adjusted for competition between facilities, was most accurate and selected as the best-fit model. It estimated that 63% of the population of the study districts were within the 1 h national access benchmark, against 82% estimated by the Euclidean model.Conclusions Extrapolating the results from the best-fit model in study districts to the national level shows that approximately six million people are currently incorrectly estimated to have access to government health services within 1 h. Simple Euclidean distance assumptions, which underpin needs assessments and against which millennium development goals are evaluated, thus require reconsideration.