The effect of distance from home on attendance at a small rural health centre in Papua New Guinea
The effect of distance from home on attendance at a small rural health centre in Papua New Guinea
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DOI：
10.1093/ije/27.5.878
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发表时间：
1998-10-01
影响因子：
7.7
通讯作者：
Genton, B
中科院分区：
文献类型：
--
作者：
Müller, I;Smith, T;Genton, B
背景热带农村地区的患者到初级卫生保健机构寻求医疗费用的意愿受到他们旅行距离的影响，但很少有研究试图估计这些距离的影响。方法从巴布亚新几内亚一个农村卫生中心4348名就诊者的数据库中估计距离衰减对就诊率的影响，并将其与人口统计和住房位置数据联系起来。结果总的就诊率随距离的增加而显著下降(3.5公里处下降50%)，疟疾或急性呼吸道感染患者的就诊率随距离的增加而显著下降。这一下降是(在对数尺度上)随距离的非线性变化。尽管随着时间的推移，这种距离效应在年龄和性别组之间存在很大差异：女性患者在青少年和成年人中表现出较少的距离衰退，但在婴儿组中表现得更高。空间模式解释了年龄和性别特定出席率变化的32%。在空间效应中，超过50%是由距离效应引起的。结论距离效应的大小与其他报道的相似，表明距离效应可以推广到热带农村的许多地区。距离衰减的非线性表明，在卫生规划中应使用钟形需求函数。
Backgound The willingness of patients in the rural tropics to seek medical fare at primary health care facilities is influenced by the distance they have to travel, but few studies have tried to estimate these distance effects.Methods Distance decay effects in attendance rates were estimated from a database of 4348 attendances at a rural health centre in Papua New Guinea, linked to demographic and house position data for the catchment population. Small-scale spatial patterns and differences between diagnoses, age groups and gender are described.Results Attendance decreased markedly with distance both overall (50% decrease at 3.5 km) and for patients with malaria or acute respiratory infections. This decrease was non-linear (on log scale) with distance. Although constant over time, there were big differences in this distance effect among age and gender groups: Female patients showed less distance decay in adolescents and adults, bur higher in the infant group. Spatial patterns accounted for 32% of the variation in age- and gender-specific attendance rates. Of the spatial effects more than 50% were due to distance effects.Conclusions Distance effects were similar in magnitude to those reported elsewhere, suggesting that distance effects may be generalizable to many parts of the rural tropics. The non-linearity of distance decay implies that a bell-shaped demand function should be used in health planning.