scholarly journals Improving geographical accessibility modeling for operational use by local health actors

2020 ◽  
Author(s):  
Felana Angella Ihantamalala ◽  
Vincent Herbreteau ◽  
Christophe Révillion ◽  
Mauricianot Randriamihaja ◽  
Jérémy Commins ◽  
...  
Keyword(s):  
Rural Areas ◽  
Local Level ◽  
Travel Speed ◽  
Local Health ◽  
Residential Areas ◽  
Geographic Accessibility ◽  
Geographical Access ◽  
Shortest Route ◽  
Context Specific ◽  
Geographical Accessibility

AbstractBackgroundGeographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations.MethodsWe used a participatory approach to map all the paths, residential areas, buildings and rice fields on OpenStreetMap (OSM). We estimated shortest route from every household in the District to the nearest primary health care center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest route estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny.ResultsWe mapped over 100,000 buildings, 23,000 km of footpaths, and 4,925 residential areas throughout Ifanadiana district; this data is freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10-15% lived more than one hour away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 hours away, and vulnerable populations across the district with poor geographical access (>1 hour) to both PHCs and CHSs.ConclusionOur study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage in rural areas throughout world.

scholarly journals Improving geographical accessibility modeling for operational use by local health actors

2020 ◽  
Author(s):  
Felana Angella Ihantamalala ◽  
Vincent Herbreteau ◽  
Christophe Révillion ◽  
Mauricianot Randriamihaja ◽  
Jérémy Commins ◽  
...  
Keyword(s):  
Rural Areas ◽  
Local Level ◽  
Travel Speed ◽  
Local Health ◽  
Residential Areas ◽  
Geographic Accessibility ◽  
Geographical Access ◽  
Shortest Route ◽  
Context Specific ◽  
Geographical Accessibility

Abstract Background Geographical accessibility to health facilities remains one of the main barriers to access care in rural areas of the developing world. Although methods and tools exist to model geographic accessibility, the lack of basic geographic information prevents their widespread use at the local level for targeted program implementation. The aim of this study was to develop very precise, context-specific estimates of geographic accessibility to care in a rural district of Madagascar to help with the design and implementation of interventions that improve access for remote populations. Methods We used a participatory approach to map all the paths, residential areas, buildings and rice fields on OpenStreetMap (OSM). We estimated shortest route from every household in the District to the nearest primary health care center (PHC) and community health site (CHS) with the Open Source Routing Machine (OSMR) tool. Then, we used remote sensing methods to obtain a high resolution land cover map, a digital elevation model and rainfall data to model travel speed. Travel speed models were calibrated with field data obtained by GPS tracking in a sample of 168 walking routes. Model results were used to predict travel time to seek care at PHCs and CHSs for all the shortest route estimated earlier. Finally, we integrated geographical accessibility results into an e-health platform developed with R Shiny. Results We mapped over 100,000 buildings, 23,000 km of footpaths, and 4,925 residential areas throughout Ifanadiana district; this data is freely available on OSM. We found that over three quarters of the population lived more than one hour away from a PHC, and 10-15% lived more than one hour away from a CHS. Moreover, we identified areas in the North and East of the district where the nearest PHC was further than 5 hours away, and vulnerable populations across the district with poor geographical access (>1 hour) to both PHCs and CHSs. Conclusion Our study demonstrates how to improve geographical accessibility modeling so that results can be context-specific and operationally actionable by local health actors. The importance of such approaches is paramount for achieving universal health coverage in rural areas throughout world.

scholarly journals Geospatial patterns of comorbidity prevalence among people with osteoarthritis in Alberta Canada

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xiaoxiao Liu ◽  
Rizwan Shahid ◽  
Alka B. Patel ◽  
Terrence McDonald ◽  
Stefania Bertazzon ◽  
...  
Keyword(s):  
First Nations ◽  
Rural Areas ◽  
Urban Areas ◽  
Hot Spot ◽  
Local Level ◽  
Moran’S I ◽  
Local Health ◽  
Case Definitions ◽  
Moran's I ◽  
Remote Areas

Abstract Background Knowledge of geospatial pattern in comorbidities prevalence is critical to an understanding of the local health needs among people with osteoarthritis (OA). It provides valuable information for targeting optimal OA treatment and management at the local level. However, there is, at present, limited evidence about the geospatial pattern of comorbidity prevalence in Alberta, Canada. Methods Five administrative health datasets were linked to identify OA cases and comorbidities using validated case definitions. We explored the geospatial pattern in comorbidity prevalence at two standard geographic areas levels defined by the Alberta Health Services: descriptive analysis at rural-urban continuum level; spatial analysis (global Moran’s I, hot spot analysis, cluster and outlier analysis) at the local geographic area (LGA) level. We compared area-level indicators in comorbidities hotspots to those in the rest of Alberta (non-hotspots). Results Among 359,638 OA cases in 2013, approximately 60% of people resided in Metro and Urban areas, compared to 2% in Rural Remote areas. All comorbidity groups exhibited statistically significant spatial autocorrelation (hypertension: Moran’s I index 0.24, z score 4.61). Comorbidity hotspots, except depression, were located primarily in Rural and Rural Remote areas. Depression was more prevalent in Metro (Edmonton-Abbottsfield: 194 cases per 1000 population, 95%CI 192–195) and Urban LGAs (Lethbridge-North: 169, 95%CI 168–171) compared to Rural areas (Fox Creek: 65, 95%CI 63–68). Comorbidities hotspots included a higher percentage of First Nations or Inuit people. People with OA living in hotspots had lower socioeconomic status and less access to care compared to non-hotspots. Conclusions The findings highlight notable rural-urban disparities in comorbidities prevalence among people with OA in Alberta, Canada. Our study provides valuable evidence for policy and decision makers to design programs that ensure patients with OA receive optimal health management tailored to their local needs and a reduction in current OA health disparities.

scholarly journals Disparities in Geographical Access to Hospitals in Portugal

2020 ◽  
Vol 9 (10) ◽  
pp. 567
Author(s):  
Claudia Costa ◽  
José António Tenedório ◽  
Paula Santana
Keyword(s):  
Health Care Services ◽  
Local Level ◽  
Premature Mortality ◽  
Health It ◽  
Care Services ◽  
Driving Time ◽  
Geographical Access ◽  
Small Area Level ◽  
Older Populations ◽  
Geographical Accessibility

Geographical accessibility to health care services is widely accepted as relevant to improve population health. However, measuring it is very complex, mainly when applied at administrative levels that go beyond the small-area level. This is the case in Portugal, where the municipality is the administrative level that is most appropriate for implementing policies to improve the access to those services. The aim of this paper is to assess whether inequalities in terms of access to a hospital in Portugal have improved over the last 20 years. A population-weighted driving time was applied using the census tract population, the roads network, the reference hospitals’ catchment area and the municipality boundaries. The results show that municipalities are 25 min away from the hospital—3 min less than in 1991—and that there is an association with premature mortality, elderly population and population density. However, disparities between municipalities are still huge. Municipalities with higher rates of older populations, isolated communities or those located closer to the border with Spain face harder challenges and require greater attention from local administration. Since municipalities now have responsibilities for health, it is important they implement interventions at the local level to tackle disparities impacting access to healthcare.

scholarly journals Geographic barriers to establishing a successful hospital referral system in rural Madagascar

2021 ◽  
Author(s):  
Felana Angella Ihantamalala ◽  
Matthew H. Bonds ◽  
Mauricianot Randriamihaja ◽  
Luc Rakotonirina ◽  
Vincent Herbreteau ◽  
...  
Keyword(s):  
Health System ◽  
Universal Health Coverage ◽  
Travel Speed ◽  
Health System Strengthening ◽  
Local Health ◽  
Health Coverage ◽  
Geographic Accessibility ◽  
Hospital Referral ◽  
The Impact ◽  
Universal Health

Background: The provision of emergency and hospital care has become an integral part of the global vision for universal health coverage. It is recommended that at least 80% of a country s population should be within two hours of a facility with essential surgery and anesthetic services. In order to strengthen health systems to achieve this goal, there needs to be an understanding of the time necessary for populations to reach a hospital. The goal of this study was to develop methods that accurately estimate referral and pre-hospital time for rural health districts in LMICs. We used these estimates to assess how the local geography can limit the impact of a strengthened referral program in a rural district of Madagascar. Methods: We developed a database containing 1) travel speed in a subset of routes by foot and motorized vehicles in Ifanadiana District; 2) a full mapping of all roads, footpaths and households in the district; and 3) remotely sensed data on terrain, land cover and climatic characteristics. We used this information to calibrate estimates of referral and pre-hospital time based on shortest route algorithms and statistical models of local travel speed. We compared these estimates with those from other commonly used methods in geographic accessibility modeling. Finally, we studied the impact of referral time on the evolution of the number of referrals completed by each health center in the district in 2014-2020 via generalized linear mixed models, using model estimates to predict the impact on referral numbers of strategies aimed at reducing referral time for underserved populations. Results: About 10% of the population lived less than two hours from the hospital, and more than half lived over four hours away, with variable access depending on climatic conditions. Only the four health centers (out of 21) located near the paved road had referral times to the hospital within one hour, which contributed over 75% of all 8,464 hospital referrals. Referral time remained the main barrier limiting the number of referrals despite health system strengthening efforts. The addition of two new referral centers is estimated to triple the population living within two hours from a center with higher acute care capacity and nearly double the number of referrals expected. Conclusion: This study demonstrates how adapting geographic accessibility modeling methods to local scales can occur through improving the precision of travel time estimates and pairing them with data on health facility data. Such information can substantially improve the design of a local health system to overcome existing barriers to care and achieve universal health coverage.

Regime of soil humus rural residential areas organic farming systems

2018 ◽  
Vol 2 (95) ◽  
pp. 78-81
Author(s):  
L.I. Shkarivska
Keyword(s):  
Organic Farming ◽  
Rural Areas ◽  
Humus Content ◽  
Farming Systems ◽  
Farming System ◽  
Organic Substrates ◽  
Residential Areas ◽  
Typical Chernozem ◽  
Podzolic Soils ◽  
Organic Farming System

The changes of the soil’s humus soil within the rural areas are investigated for the organic farming system. The most significant impact of organic agriculture on humus content over 55% was observed on soddy podzolic soils (V>75%), the lowest –7,5% on typical chernozem (V≈16%). Changes in the qualitative composition of humus for the introduction of various types of organic substrates are analyzed.

Impact of Elected Women Representatives of Panchayati Raj in Physical and Financial and Business Assets Development of Rural Women: A Study among the Rural Women’s of Tiruvannamalai District, Tamil Nadu[1]

2017 ◽  
Vol 4 (24) ◽  
Author(s):  
Kalaichelvi Sivaraman ◽  
Rengasamy Stalin
Keyword(s):  
Rural Women ◽  
Rural Areas ◽  
Urban Areas ◽  
Direct Democracy ◽  
Tamil Nadu ◽  
Local Level ◽  
Rural And Urban Areas ◽  
The Government ◽  
The Impact ◽  
Panchayati Raj

This research paper is the part of Research Project entitled “Impact of Elected Women Representatives in the Life and Livelihood of the Women in Rural Areas: With Special Reference to Tiruvannamalai District, Tamil Nadu” funded by University of Madras under UGC-UPE Scheme.The 73rd and 74th amendments of the Constitution of India were made by the government to strengthen the position of women and to create a local-level legal foundation for direct democracy for women in both rural and urban areas. The representation for women in local bodies through reservation policies amendment in Constitution of India has stimulated the political participation of women in rural areas. However, when it’s comes to the argument of whether the women reservation in Panchayati Raj helps or benefits to the life and livelihood development of women as a group? The answer is hypothetical because the studies related to the impact of women representatives of Panchayati Raj in the life and livelihood development of women was very less. Therefore, to fill the gap in existing literature, the present study was conducted among the rural women of Tiruvannamalai district to assess the impact of elected women representatives in the physical and financial and business development of the women in rural areas. The findings revealed that during the last five years because of the women representation in their village Panjayati Raj, the Physical Asset of the rural women were increased or developed moderately (55.8%) and Highly (23.4%) and the Financial and Business Asset of the rural women were increased or developed moderately (60.4%) and Highly (18.7%).

scholarly journals Quick and collaborative response to teenage pregnancies in a poor semi-rural area of Belgium

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
V Déom ◽  
L Ben Abdelhafidh ◽  
N Annez ◽  
C Glorie ◽  
M Roland
Keyword(s):  
Family Planning ◽  
Reproductive Health ◽  
Rural Areas ◽  
Sexual And Reproductive Health ◽  
Health Clinic ◽  
Local Health ◽  
Reproductive Health Services ◽  
Sexually Transmitted ◽  
Victims Of Violence ◽  
The City

Abstract Early pregnancies are often linked to precarious situations. Even if Belgium has seen a decrease in teenage pregnancies, in the former mining region of the Hainaut there are still twice as many births to young women under 20 compared to the national rate. Colfontaine is one of the poorest cities in Belgium. Last year, one of the local high schools counted 10 pregnant teenagers out of 450 students. Médecins du Monde was already present in the city at the time with a mobile health clinic called the Médibus. In response, we carried out a mapping of the local sexual and reproductive health actors. The lack of accessibility to social and health structures capable of welcoming teenagers anonymously and free of charge quickly emerged as a problem, the nearest family planning center being located 30 minutes away by bus. In September 2019, in partnership with 5 local health actors, we decided to reshape the Médibus into the Adobus in order to offer family planning consultations, health promotion and harm reduction activities at the high school once a week. In addition to offering health information services, we also aim to detect teenagers experiencing vulnerable situations such as addiction, violence, gender issues and refer them to appropriate services. Halfway through the project, we met 430 teenagers in 14 afternoons. The most common reasons for consultation (N = 310) were questions related to contraception for 29% and to sexually transmitted infections for 24,5%. 70,9% of teenagers received condoms and 13 girls were tested for pregnancy. One girl received a morning-after pill. 3 teenagers with addiction problems and 17 victims of violence were detected. The teams referred 18 teenagers to other services. The success of this outreach project confirms the need for information regarding sexual and reproductive health for teenagers living in precarious situations as well as the need to develop reachable and affordable sexual and reproductive health services in semi-rural areas. Key messages Outreach is an efficient approach to respond to teenagers’ needs in poor semi-rural areas. Outreach facilitated the detection of early pregnancies, addiction and violence issues among teenagers.

Building Health Communities: Local Health Care Networks in Maryland

2019 ◽  
Vol 50 (1) ◽  
pp. 62-76 ◽  
Author(s):  
Aaron Wachhaus
Keyword(s):  
Health Care ◽  
Local Level ◽  
Collaborative Networks ◽  
Local Health ◽  
Exploratory Research ◽  
The Public ◽  
Health Care Networks ◽  
Local Health Care ◽  
Health Communities ◽  
Treatment Of Obesity

Combatting chronic disease (prevention and treatment of obesity, diabetes, heart health, and stroke) requires action at the local level, both to educate the public and to provide health services. Effective collaboration among local organizations devoted to educating the public about, and treating patients of, these diseases is a key component of successful health care. To better understand local efforts, a social network analysis of five local health care networks spanning eight counties in Maryland was conducted. The purpose of this exploratory research was to discover whether collaborative networks exist at the local level, to map the networks, and to assess their strengths and needs.

scholarly journals Geographical access to critical care services in Scotland

2017 ◽  
Vol 19 (1) ◽  
pp. 6-14 ◽  
Author(s):  
Philip Emerson ◽  
Naomi Dodds ◽  
David R Green ◽  
Jan O Jansen
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Rural Areas ◽  
Care Facility ◽  
Population Data ◽  
Small Towns ◽  
Health Board ◽  
Care Services ◽  
Geographical Access ◽  
Scottish Population

Background Critical illness requires specialist and timely management. The aim of this study was to create a geographic accessibility profile of the Scottish population to emergency departments and intensive care units. Methods This was a descriptive, geographical analysis of population access to ‘intermediate’ and ‘definitive’ critical care services in Scotland. Access was defined by the number of people able to reach services within 45 to 60 min, by road and by helicopter. Access was analysed by health board, rurality and as a country using freely available geographically referenced population data. Results Ninety-six percent of the population reside within a 45-min drive of the nearest intermediate critical care facility, and 94% of the population live within a 45-min ambulance drive time to the nearest intensive care unit. By helicopter, these figures were 95% and 91%, respectively. Some health boards had no access to definitive critical care services within 45 min via helicopter or road. Very remote small towns and very remote rural areas had poorer access than less remote and rural regions.

scholarly journals Eliminating Neglected Tropical Diseases in Urban Areas: A Review of Challenges, Strategies and Research Directions for Successful Mass Drug Administration

2018 ◽  
Vol 3 (4) ◽  
pp. 122 ◽  
Author(s):  
Alayne Adams ◽  
Myriam Vuckovic ◽  
Eleanor Birch ◽  
Tara Brant ◽  
Stephanie Bialek ◽  
...  
Keyword(s):  
Drug Administration ◽  
Mass Drug Administration ◽  
Rural Areas ◽  
Urban Areas ◽  
Neglected Tropical Diseases ◽  
Monitoring And Evaluation ◽  
Population Heterogeneity ◽  
Tropical Diseases ◽  
Urban Settings ◽  
Context Specific

Since 1950, the global urban population grew from 746 million to almost 4 billion and is expected to reach 6.4 billion by mid-century. Almost 90% of this increase will take place in Asia and Africa and disproportionately in urban slums. In this context, concerns about the amplification of several neglected tropical diseases (NTDs) are warranted and efforts towards achieving effective mass drug administration (MDA) coverage become even more important. This narrative review considers the published literature on MDA implementation for specific NTDs and in-country experiences under the ENVISION and END in Africa projects to surface features of urban settings that challenge delivery strategies known to work in rural areas. Discussed under the thematics of governance, population heterogeneity, mobility and community trust in MDA, these features include weak public health infrastructure and programs, challenges related to engaging diverse and dynamic populations and the limited accessibility of certain urban settings such as slums. Although the core components of MDA programs for NTDs in urban settings are similar to those in rural areas, their delivery may need adjustment. Effective coverage of MDA in diverse urban populations can be supported by tailored approaches informed by mapping studies, research that identifies context-specific methods to increase MDA coverage and rigorous monitoring and evaluation.

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