Geographical access to care at birth in Ghana: a barrier to safe motherhood.
Geographical access to care at birth in Ghana: a barrier to safe motherhood.
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加纳出生时获得护理的地理通道：安全母性的障碍。
DOI：
10.1186/1471-2458-12-991
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发表时间：
2012-11-16
影响因子：
4.5
通讯作者：
Atkinson PM
中科院分区：
文献类型：
--
作者：
Gething PW;Johnson FA;Frempong-Ainguah F;Nyarko P;Baschieri A;Aboagye P;Falkingham J;Matthews Z;Atkinson PM
适当的分娩护理设施是安全孕产的一个关键决定因素，但在许多高负担地区，获得护理的地理条件仍然很差。尽管地理可及性很重要，但很少对它进行系统审计，妨碍了将其纳入国家一级的孕产妇保健系统评估和规划。在这项研究中，我们开发了一套独特的详细的空间关联数据和校准的地理空间模型，以进行全国范围的审计，在加纳，一个典型的高负担的国家，许多在撒哈拉以南非洲地区出生的孕产妇保健的地理访问。我们收集了关于人口、卫生设施和影响旅程的景观特征的详细空间数据。这些被用于地理空间模型，以估计所有育龄妇女（WoCBA）到最近的医疗机构的旅行时间，这些医疗机构在分娩时提供不同程度的护理，同时考虑到不同的交通类型和可用性。我们使用寻求护理的妇女的实际行程数据校准了模型。我们发现，加纳三分之一（34%）的妇女生活在可能提供紧急产科和新生儿护理（EmONC）的设施的临床显著两小时阈值以上，这些设施被归类为“部分”标准或更好。近一半（45%）的人住在离“综合性”EmONC设施那么远或更远的地方，这些设施提供挽救生命的输血和手术。在最偏远的地区，这些数字分别上升到63%和81%。在许多达到基于人均设施比率的国际目标的区域，获得服务的水平很低。详细的数据集合与地理空间建模相结合，可以提供全国范围的出生护理地理访问审计，以支持系统的孕产妇保健规划，人力资源部署和战略目标。目前关于产妇保健服务的国际基准不足以达到这些目的，因为它们没有考虑到服务的地点和相对于所服务的妇女的可获得性。
Appropriate facility-based care at birth is a key determinant of safe motherhood but geographical access remains poor in many high burden regions. Despite its importance, geographical access is rarely audited systematically, preventing integration in national-level maternal health system assessment and planning. In this study, we develop a uniquely detailed set of spatially-linked data and a calibrated geospatial model to undertake a national-scale audit of geographical access to maternity care at birth in Ghana, a high-burden country typical of many in sub-Saharan Africa. We assembled detailed spatial data on the population, health facilities, and landscape features influencing journeys. These were used in a geospatial model to estimate journey-time for all women of childbearing age (WoCBA) to their nearest health facility offering differing levels of care at birth, taking into account different transport types and availability. We calibrated the model using data on actual journeys made by women seeking care. We found that a third of women (34%) in Ghana live beyond the clinically significant two-hour threshold from facilities likely to offer emergency obstetric and neonatal care (EmONC) classed at the ‘partial’ standard or better. Nearly half (45%) live that distance or further from ‘comprehensive’ EmONC facilities, offering life-saving blood transfusion and surgery. In the most remote regions these figures rose to 63% and 81%, respectively. Poor levels of access were found in many regions that meet international targets based on facilities-per-capita ratios. Detailed data assembly combined with geospatial modelling can provide nation-wide audits of geographical access to care at birth to support systemic maternal health planning, human resource deployment, and strategic targeting. Current international benchmarks of maternal health care provision are inadequate for these purposes because they fail to take account of the location and accessibility of services relative to the women they serve.
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影响因子：
3.7
作者：
BATTESE, GE;HARTER, RM;FULLER, WA
通讯作者：
FULLER, WA
影响因子：
10.3
作者：
Choi, Yosoon;Nieto, Antonio
通讯作者：
Nieto, Antonio
影响因子：
15.8
作者：
Gabrysch S;Cousens S;Cox J;Campbell OM
通讯作者：
Campbell OM
DOI：
10.1007/s11524-010-9481-1
发表时间：
2011-06
影响因子：
6.6
作者：
Essendi, Hildah;Mills, Samuel;Fotso, Jean-Christophe
通讯作者：
Fotso, Jean-Christophe
影响因子：
7.9
作者：
Bagli, Stefano;Geneletti, Davide;Orsi, Francesco
通讯作者：
Orsi, Francesco