It's a long, long walk: accessibility to hospitals, maternity and integrated health centers in Niger
It's a long, long walk: accessibility to hospitals, maternity and integrated health centers in Niger
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DOI：
10.1186/1476-072x-11-24
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发表时间：
2012-06-27
影响因子：
4.9
通讯作者：
MacEachren, Alan M.
中科院分区：
文献类型：
--
作者：
Blanford, Justine I.;Kumar, Supriya;MacEachren, Alan M.
背景资料：在任何国家，特别是在尼日尔这样的国家，获得保健服务的便利都是非常重要的，因为在这些国家，限制获得保健服务会使人们面临因麻疹、脑膜炎、小儿麻痹症、肺炎和疟疾等疾病而死亡的风险。本文分析了尼日尔内人口实际获得卫生设施的情况，重点是季节性条件的影响以及这些条件在提供充分的卫生服务、提供药物和接种疫苗方面的影响。尼日尔境内的大部分交通工具是步行，因此，本文件强调步行前往护理设施的机会。进一步的分析比较了无障碍的车辆旅行的变化，因为公共卫生工作者的旅行时，车辆进行疫苗接种运动和相关的积极主动的卫生保健activities.Results：在尼日尔的大部分道路是非铺砌（90%）。主要在Tahoua地区的六个县缺乏医疗设施。阿加德兹的病人与保健设施的比率最好，每个保健设施为7 000人提供服务。在旱季，39%的人口在1小时步行范围内到达保健中心，在雨季，这一比例下降到24%。进一步的分析表明，疫苗接种率与距离密切相关。生活在距离卫生中心1小时路程内的儿童在1岁时完成疫苗接种的几率是生活在远离卫生中心的儿童的1.88倍（p < 0.05）。三个关键的地理区域被强调，在那里获得保健中心需要超过4小时的步行在潮湿和干燥的季节。超过730，000人可以在这些地区增加17个卫生设施，以改善目前的总数504在旱季（260，000在雨季）。结论：这项研究突出了在尼日尔的关键领域，卫生服务/设施缺乏。第二项调查结果是，如果只在旱季进行评估，将严重高估保健设施服务的人口。映射的输出可用于未来的决策过程和分析。
Background: Ease of access to health care is of great importance in any country but particularly in countries such as Niger where restricted access can put people at risk of mortality from diseases such as measles, meningitis, polio, pneumonia and malaria. This paper analyzes the physical access of populations to health facilities within Niger with an emphasis on the effect of seasonal conditions and the implications of these conditions in terms of availability of adequate health services, provision of drugs and vaccinations. The majority of the transport within Niger is pedestrian, thus the paper emphasizes access by those walking to facilities for care. Further analysis compared the change in accessibility for vehicular travel since public health workers do travel by vehicle when carrying out vaccination campaigns and related proactive health care activities.Results: The majority of the roads in Niger are non-paved (90%). Six districts, mainly in the region of Tahoua lack medical facilities. Patient to health facility ratios were best in Agadez with 7000 people served per health facility. During the dry season 39% of the population was within 1-hours walk to a health center, with the percentage decreasing to 24% during the wet season. Further analyses revealed that vaccination rates were strongly correlated with distance. Children living in clusters within 1-hour of a health center had 1.88 times higher odds of complete vaccination by age 1-year compared to children living in clusters further from a health center (p < 0.05). Three key geographic areas were highlighted where access to health centers took greater than 4 h walk during the wet and dry season. Access for more than 730,000 people can be improved in these areas with the addition of 17 health facilities to the current total of 504 during the dry season (260,000 during the wet season).Conclusions: This study highlights critical areas in Niger where health services/facilities are lacking. A second finding is that population served by health facilities will be severely overestimated if assessments are solely conducted during the dry season. Mapped outputs can be used for future decision making processes and analysis.