Comparing absolute and relative distance and time travel measures of geographic access to healthcare facilities in rural Haiti.

Autor:	Bhangdia KP; Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA kbhangdia@gmail.com.; Institute for Health Metrics and Evaluation, Seattle, Washington, USA., Iyer HS; Division of Population Science, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, Massachusetts, USA., Joseph JP; Partners In Health/Zanmi Lasante, Mirebalais, Haiti., Dorne RL; Partners In Health/Zanmi Lasante, Mirebalais, Haiti., Mukherjee J; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.; Partners In Health, Boston, Massachusetts, USA., Fadelu T; Division of Population Science, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2022 May 24; Vol. 12 (5), pp. e056123. Date of Electronic Publication: 2022 May 24.
DOI:	10.1136/bmjopen-2021-056123
Abstrakt:	Introduction: While travel distance and time are important proxies of physical access to health facilities, obtaining valid measures with an appropriate modelling method remains challenging in many settings. We compared five measures of geographic accessibility in Haiti, producing recommendations that consider available analytic resources and geospatial goals. Methods: Eight public hospitals within the ministry of public health and population were included. We estimated distance and time between hospitals and geographic centroids of Haiti's section communes and population-level accessibility. Geographic feature data were obtained from public administrative databases, academic research databases and government satellites. We used validated geographic information system methods to produce five geographic access measures: (1) Euclidean distance (ED), (2) network distance (ND), (3) network travel time (NTT), (4) AccessMod 5 (AM5) distance (AM5D) and (5) AM5 travel time (AM5TT). Relative ranking of section communes across the measures was assessed using Pearson correlation coefficients, while mean differences were assessed using analysis of variance (ANOVA) and pairwise t-tests. Results: All five geographic access measures were highly correlated (range: 0.78-0.99). Of the distance measures, ED values were consistently the shortest, followed by AM5D values, while ND values were the longest. ND values were as high as 2.3 times ED values. NTT models generally produced longer travel time estimates compared with AM5TT models. ED consistently overestimated population coverage within a given threshold compared with ND and AM5D. For example, population-level accessibility within 15 km of the nearest studied hospital in the Center department was estimated at 68% for ED, 50% for AM5D and 34% for ND. Conclusion: While the access measures were highly correlated, there were significant differences in the absolute measures. Consideration of the benefits and limitations of each geospatial measure together with the intended purpose of the estimates, such as relative proximity of patients or service coverage, are key to guiding appropriate use. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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