scholarly journals Geospatial mapping of access to timely essential surgery in sub-Saharan Africa

2018 ◽  
Vol 3 (4) ◽  
pp. e000875 ◽  
Author(s):  
Sabrina Juran ◽  
P. Niclas Broer ◽  
Stefanie J. Klug ◽  
Rachel C. Snow ◽  
Emelda A. Okiro ◽  
...  
Keyword(s):  
Travel Time ◽  
Sub Saharan Africa ◽  
Ancillary Data ◽  
Surgical Disease ◽  
Country Level ◽  
Time Estimates ◽  
Essential Surgery ◽  
Scale Population ◽  
Estimate Travel Time ◽  
Sub Saharan

IntroductionDespite an estimated one-third of the global burden of disease being surgical, only limited estimates of accessibility to surgical treatment in sub-Saharan Africa exist and these remain spatially undefined. Geographical metrics of access to major hospitals were estimated based on travel time. Estimates were then used to assess need for surgery at country level.MethodsMajor district and regional hospitals were assumed to have capability to perform bellwether procedures. Geographical locations of hospitals in relation to the population in the 47 sub-Saharan countries were combined with spatial ancillary data on roads, elevation, land use or land cover to estimate travel-time metrics of 30 min, 1 hour and 2 hours. Hospital catchment was defined as population residing in areas less than 2 hours of travel time to the next major hospital. Travel-time metrics were combined with fine-scale population maps to define burden of surgery at hospital catchment level.ResultsOverall, the majority of the population (92.5%) in sub-Saharan Africa reside in areas within 2 hours of a major hospital catchment defined based on spatially defined travel times. The burden of surgery in all-age population was 257.8 million to 294.7 million people and was highest in high-population density countries and lowest in sparsely populated or smaller countries. The estimated burden in children <15 years was 115.3 million to 131.8 million and had similar spatial distribution to the all-age pattern.ConclusionThe study provides an assessment of accessibility and burden of surgical disease in sub-Saharan Africa. Yet given the optimistic assumption of adequare surgical capability of major hospitals, the true burden of surgical disease is expected to be much greater. In-depth health facility assessments are needed to define infrastructure, personnel and medicine supply for delivering timely and safe affordable surgery to further inform the analysis.

scholarly journals Promoting Scale-Up Across a Global Project Platform: Lessons from the Evidence to Action Project

2021 ◽  
Author(s):  
Laura Ghiron ◽  
Eric Ramirez-Ferrero ◽  
Rita Badiani ◽  
Regina Benevides ◽  
Alexis Ntabona ◽  
...  
Keyword(s):  
Family Planning ◽  
Scale Up ◽  
Scaling Up ◽  
Sub Saharan Africa ◽  
Health System Strengthening ◽  
Country Level ◽  
Look Ahead ◽  
Republic Of The Congo ◽  
Sub Saharan ◽  
Multi Stakeholder

AbstractThe USAID-funded flagship family planning service delivery project named Evidence to Action (E2A) worked from 2011 to 2021 to improve family planning and reproductive health for women and girls across seventeen nations in sub-Saharan Africa using a “scaling-up mindset.” The paper discusses three key lessons emerging from the project’s experience with applying ExpandNet’s systematic approach to scale up. The methodology uses ExpandNet/WHO’s scaling-up framework and guidance tools to design and implement pilot or demonstration projects in ways that look ahead to their future scale-up; develop a scaling-up strategy with local stakeholders; and then strategically manage the scaling-up process. The paper describes how a scaling-up mindset was engendered, first within the project’s technical team in Washington and then how they subsequently sought to build capacity at the country level to support scale-up work throughout E2A’s portfolio of activities. The project worked with local multi-stakeholder resource teams, often led by government officials, to equip them to lead the scale-up of family planning and health system strengthening interventions. Examples from project experience in the Democratic Republic of the Congo, Kenya, Nigeria, and Uganda illustrating key concepts are discussed. E2A also established a community of practice on systematic approaches to scale up as a platform for sharing learning across a variety of technical agencies engaged in scale-up work and to create learning opportunities for interacting with thought leaders around critical scale-up issues.

scholarly journals Exploring country-wide equitable government health care facility access in Uganda

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Nicholas Dowhaniuk
Keyword(s):  
Health Care ◽  
Random Forest ◽  
Health Center ◽  
Travel Time ◽  
Health Centers ◽  
Sub Saharan Africa ◽  
Walking Distance ◽  
Laboratory System ◽  
Government Health ◽  
Sub Saharan

Abstract Background Rural access to health care remains a challenge in Sub-Saharan Africa due to urban bias, social determinants of health, and transportation-related barriers. Health systems in Sub-Saharan Africa often lack equity, leaving disproportionately less health center access for the poorest residents with the highest health care needs. Lack of health care equity in Sub-Saharan Africa has become of increasing concern as countries enter a period of simultaneous high infectious and non-communicable disease burdens, the second of which requires a robust primary care network due to a long continuum of care. Bicycle ownership has been proposed and promoted as one tool to reduce travel-related barriers to health-services among the poor. Methods An accessibility analysis was conducted to identify the proportion of Ugandans within one-hour travel time to government health centers using walking, bicycling, and driving scenarios. Statistically significant clusters of high and low travel time to health centers were calculated using spatial statistics. Random Forest analysis was used to explore the relationship between poverty, population density, health center access in minutes, and time saved in travel to health centers using a bicycle instead of walking. Linear Mixed-Effects Models were then used to validate the performance of the random forest models. Results The percentage of Ugandans within a one-hour walking distance of the nearest health center II is 71.73%, increasing to 90.57% through bicycles. Bicycles increased one-hour access to the nearest health center III from 53.05 to 80.57%, increasing access to the tiered integrated national laboratory system by 27.52 percentage points. Significant clusters of low health center access were associated with areas of high poverty and urbanicity. A strong direct relationship between travel time to health center and poverty exists at all health center levels. Strong disparities between urban and rural populations exist, with rural poor residents facing disproportionately long travel time to health center compared to wealthier urban residents. Conclusions The results of this study highlight how the most vulnerable Ugandans, who are the least likely to afford transportation, experience the highest prohibitive travel distances to health centers. Bicycles appear to be a “pro-poor” tool to increase health access equity.

Migration as a Risk Factor for HIV Infection among Youths in Sub-Saharan Africa

2013 ◽  
Vol 648 (1) ◽  
pp. 136-158 ◽  
Author(s):  
Monica A. Magadi
Keyword(s):  
Risk Factor ◽  
Hiv Infection ◽  
Urban Areas ◽  
Young Female ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Country Level ◽  
Female Migrants ◽  
Sub Saharan ◽  
Living With Hiv

Of the estimated 10 million youths living with HIV worldwide, 63 percent live in sub-Saharan Africa. This article focuses on migration as a risk factor of HIV infection among the youths in sub-Saharan Africa. The study is based on multilevel modeling, applied to the youth sample of the Demographic and Health Surveys (DHS), conducted from 2003 to 2008 in nineteen countries. The analysis takes into account country-level and regional-level variations. The results suggest that across countries in sub-Saharan Africa, migrants have on average about 50 percent higher odds of HIV infection than nonmigrants. The higher risk among migrants is to a large extent explained by differences in demographic and socioeconomic factors. In particular, migrants are more likely to be older, to have been married, or to live in urban areas, all of which are associated with higher risks of HIV infection. The higher risk among youths who have been married is particularly pronounced among young female migrants.

scholarly journals Mapping physical access to healthcare for older adults in sub-Saharan Africa: A cross-sectional analysis with implications for the COVID-19 response

2020 ◽  
Author(s):  
Pascal Geldsetzer ◽  
Marcel Reinmuth ◽  
Paul O Ouma ◽  
Sven Lautenbach ◽  
Emelda A Okiro ◽  
...  
Keyword(s):  
Older Adults ◽  
Travel Time ◽  
Healthcare Facility ◽  
Access To Healthcare ◽  
Sub Saharan Africa ◽  
Travel Times ◽  
Healthcare Resources ◽  
Healthcare Facilities ◽  
Sub Saharan ◽  
Physical Access

Background: SARS-CoV-2, the virus causing coronavirus disease 2019 (COVID-19), is rapidly spreading across sub-Saharan Africa (SSA). Hospital-based care for COVID-19 is particularly often needed among older adults. However, a key barrier to accessing hospital care in SSA is travel time. To inform the geographic targeting of additional healthcare resources, this study aimed to determine the estimated travel time at a 1km x 1km resolution to the nearest hospital and to the nearest healthcare facility of any type for adults aged 60 years and older in SSA. Methods: We assembled a unique dataset on healthcare facilities' geolocation, separately for hospitals and any type of healthcare facility (including primary care facilities) and including both private- and public-sector facilities, using data from the OpenStreetMap project and the KEMRI Wellcome Trust Programme. Population data at a 1km x 1km resolution was obtained from WorldPop. We estimated travel time to the nearest healthcare facility for each 1km x 1km raster using a cost-distance algorithm. Findings: 9.6% (95% CI: 5.2% - 16.9%) of adults aged 60 and older years had an estimated travel time to the nearest hospital of longer than six hours, varying from 0.0% (95% CI: 0.0% - 3.7%) in Burundi and The Gambia, to 40.9% (95% CI: 31.8% - 50.7%) in Sudan. 11.2% (95% CI: 6.4% - 18.9%) of adults aged 60 years and older had an estimated travel time to the nearest healthcare facility of any type (whether primary or secondary/tertiary care) of longer than three hours, with a range of 0.1% (95% CI: 0.0% - 3.8%) in Burundi to 55.5% (95% CI: 52.8% - 64.9%) in Sudan. Most countries in SSA contained populated areas in which adults aged 60 years and older had a travel time to the nearest hospital of more than 12 hours and to the nearest healthcare facility of any type of more than six hours. The median travel time to the nearest hospital for the fifth of adults aged 60 and older years with the longest travel times was 348 minutes (IQR: 240 - 576 minutes) for the entire SSA population, ranging from 41 minutes (IQR: 34 - 54 minutes) in Burundi to 1,655 minutes (IQR: 1065 - 2440 minutes) in Gabon. Interpretation: Our high-resolution maps of estimated travel times to both hospitals and healthcare facilities of any type can be used by policymakers and non-governmental organizations to help target additional healthcare resources, such as new make-shift hospitals or transport programs to existing healthcare facilities, to older adults with the least physical access to care. In addition, this analysis shows precisely where population groups are located that are particularly likely to under-report COVID-19 symptoms because of low physical access to healthcare facilities. Beyond the COVID-19 response, this study can inform countries' efforts to improve care for conditions that are common among older adults, such as chronic non-communicable diseases.

Languages and National Identity in Sub-Saharan Africa: A Multilevel Approach

2016 ◽  
Author(s):  
Katalin Buzási
Keyword(s):  
Positive Relationship ◽  
Multilevel Models ◽  
Sub Saharan Africa ◽  
Explanatory Variables ◽  
Country Level ◽  
National Identification ◽  
Positive Attitudes ◽  
Language Knowledge ◽  
French Colonies ◽  
Sub Saharan

This chapter contributes to the recent strand of the empirical political and economic literature that attempts to reveal the determinants of national identification in Sub-Saharan Africa. Although previous survey-based studies provide evidence that the socio-economic characteristics of individuals, the properties of ethnic groups they belong to, and certain country-level variables influence the probability of having positive attitudes toward the ethnic group or the nation, the role of languages has not been studied in this context yet. Inspired by findings of psycholinguistics and related disciplines, we utilize the fourth round of the Afrobarometer Project (surveyed in 2008 and 2009) to conduct analysis on the possible positive relationship between language knowledge and identification in national versus ethnic terms. We introduce two language-related explanatory variables. First, the Index of Communication Potential (ICP) reflects the probability that an individual can communicate with another randomly selected person within the society relying on commonly spoken languages. Second, we take into account the number of spoken languages in one’s repertoire. The multilevel models show that although speaking more than two languages increases the chance of identifying in national compared to ethnic terms, the ICP is not significant in this sense on the whole sample. But, when we consider the nationality of the former colonizers, the ICP exhibits positive relationship with national identification on the sub-sample of the former French colonies.

scholarly journals Measuring Regional Ethnolinguistic Diversity in Sub-Saharan Africa: Surveys vs. GIS

2019 ◽  
Vol 34 (Supplement_1) ◽  
pp. S40-S45 ◽  
Author(s):  
Boris Gershman ◽  
Diego Rivera
Keyword(s):  
Geographic Information Systems ◽  
Rural Areas ◽  
Large Scale ◽  
Negative Association ◽  
The Other ◽  
Sub Saharan Africa ◽  
Population Surveys ◽  
Development Indicators ◽  
Scale Population ◽  
Sub Saharan

Abstract This paper compares two approaches to measuring subnational ethnolinguistic diversity in Sub-Saharan Africa, one based on censuses and large-scale population surveys and the other relying on the use of geographic information systems (GIS). The two approaches yield sets of regional fractionalization indices that show a moderately positive correlation, with a stronger association across rural areas. These differences matter for empirical analysis: in a common sample of regions, survey-based indices of deep-rooted diversity show a more strongly negative association with a range of development indicators relative to their highest-quality GIS-based counterparts.

Hybrid Information Systems for Agriculture: The Case of Cattle Trypanosomiasis in Africa

1994 ◽  
Vol 23 (4) ◽  
pp. 261-267 ◽  
Author(s):  
Iain J. Mckendrick ◽  
George Gettinby ◽  
Yiqun Gu ◽  
Andrew Peregrine ◽  
Crawford Revie
Keyword(s):  
Information Technology ◽  
Hybrid System ◽  
Food Production ◽  
Large Scale ◽  
Sub Saharan Africa ◽  
Software Systems ◽  
High Quality ◽  
Scale Population ◽  
Sub Saharan

Large scale population growth in sub-Saharan Africa makes it imperative to achieve an equivalent increase in food production in this area. It is also important that any increase be sustainable in the long-term, not causing lasting damage to local ecosystems. Recent advances in information technology make the successful diffusion of relevant expertise to farmers a more practical option than ever before. How this might be achieved is described in this paper, which considers the transfer of expertise in the diagnosis, treatment and management of trypanosomiasis in cattle. Using current technology, the combination of different software systems in one integrated hybrid system could allow the delivery of high quality, well focused information to the potential user.

Estimating HIV Prevalence and Incidence in Africa from Mortality Data

2010 ◽  
Vol 10 (1) ◽  
Author(s):  
Emily Oster
Keyword(s):  
Population Based ◽  
Hiv Prevalence ◽  
Early Years ◽  
Sub Saharan Africa ◽  
Mortality Data ◽  
Country Level ◽  
Hiv Virus ◽  
Current Prevalence ◽  
Prevalence Estimates ◽  
Sub Saharan

Abstract An estimated 33 million people are infected with the HIV virus, with 67% of them in Sub-Saharan Africa. Despite this, knowledge about HIV prevalence in Africa is limited and imperfect. Although population-based testing in recent years has provided reliable information about current prevalence in the general population, we have little reliable data on prevalence in early years of the epidemic. This paper suggests a new methodology for estimating HIV prevalence and incidence using inference from mortality data. This methodology can be used to generate prevalence estimates from early in the epidemic. This information is valuable for understanding how the epidemic has evolved over time and is also likely to be helpful in analyses that explore how policy affects the epidemic or how HIV affects other country-level outcomes.

scholarly journals Travel-time, bikes, and HIV elimination in Malawi: a geospatial modeling analysis

2020 ◽  
Author(s):  
Laurence Palk ◽  
Justin T Okano ◽  
Luckson Dullie ◽  
Sally Blower
Keyword(s):  
Travel Time ◽  
Rural Areas ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Travel Times ◽  
Geospatial Modeling ◽  
Healthcare Facilities ◽  
Fast Tracking ◽  
Sub Saharan

Background: UNAIDS has prioritized Malawi and 21 other countries in sub-Saharan Africa (SSA) for "fast-tracking" the end of their HIV epidemics. To achieve elimination requires treating 90% of people living with HIV (PLHIV); coverage is already fairly high (70-75%). However, many individuals in SSA have to walk to access healthcare. We use data-based geospatial modeling to determine whether the need to travel long distances to access treatment and limited transportation in rural areas are barriers to HIV elimination in Malawi. Additionally, we evaluate the effect on treatment coverage of increasing the availability of bicycles in rural areas. Methods: We build a geospatial model that we use to estimate, for every PLHIV, their travel-time to access HIV treatment if driving, bicycling, or walking. We estimate the travel-times needed to achieve 70% or 90% coverage. Our model includes a spatial map of healthcare facilities (HCFs), the geographic coordinates of residencies for all PLHIV, and an "impedance" map. We quantify impedance using data on road/river networks, land cover, and topography. Findings: To cross an area of one km2 in Malawi takes from ~60 seconds (driving on main roads) to ~60 minutes (walking in mountainous areas); ~80% of PLHIV live in rural areas. At ~70% coverage, HCFs can be reached within: ~45 minutes if driving, ~65 minutes if bicycling, and ~85 minutes if walking. Increasing coverage above ~70% will become progressively more difficult. To achieve 90% coverage, the travel-time for many PLHIV (who have yet to initiate treatment) will be almost twice as long as those currently on treatment. Increasing bicycle availability in rural areas reduces round-trip travel-times by almost one hour (in comparison with walking), and could substantially increase coverage levels. Interpretation: Geographic inaccessibility to treatment coupled with limited transportation in rural areas are substantial barriers to reaching 90% coverage in Malawi. Increased bicycle availability could help eliminate HIV. Funding: National Institute of Allergy and Infectious Diseases

scholarly journals Prevalence, Risk Factors, and Antimicrobial Resistance Profiles of Thermophilic Campylobacter Species in Humans and Animals in Sub-Saharan Africa: A Systematic Review

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
Noel Gahamanyi ◽  
Leonard E. G. Mboera ◽  
Mecky I. Matee ◽  
Dieudonné Mutangana ◽  
Erick V. G. Komba
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Sub Saharan Africa ◽  
Campylobacter Coli ◽  
Livestock Waste ◽  
Animal Products ◽  
Under Five ◽  
Under Five Children ◽  
Country Level ◽  
Sub Saharan

Thermophilic Campylobacter species are clinically important aetiologies of gastroenteritis in humans throughout the world. The colonization of different animal reservoirs by Campylobacter poses an important risk for humans through shedding of the pathogen in livestock waste and contamination of water sources, environment, and food. A review of published articles was conducted to obtain information on the prevalence and antimicrobial resistance (AMR) profiles of thermophilic Campylobacter species in humans and animals in sub-Saharan Africa (SSA). Electronic databases, namely, PubMed, Google Scholar, Research4life-HINARI Health, and Researchgate.net, were searched using the following search terms “thermophilic Campylobacter,” “Campylobacter jejuni,” “Campylobacter coli,” “diarrhea/diarrhoea,” “antimicrobial resistance,” “antibiotic resistance,” “humans,” “animals,” “Sub-Saharan Africa,” and “a specific country name.” Initially, a total of 614 articles were identified, and the lists of references were screened in which 22 more articles were identified. After screening, 33 articles on humans and 34 on animals and animal products were included in this review. In humans, Nigeria reported the highest prevalence (62.7%), followed by Malawi (21%) and South Africa (20.3%). For Campylobacter infections in under-five children, Kenya reported 16.4%, followed by Rwanda (15.5%) and Ethiopia (14.5%). The country-level mean prevalence in all ages and under-five children was 18.6% and 9.4%, respectively. The prevalence ranged from 1.7%–62.7% in humans and 1.2%–80% in animals. The most reported species were C. jejuni and C. coli. The AMR to commonly used antimicrobials ranged from 0–100% in both humans and animals. Poultry consumption and drinking surface water were the main risk factors for campylobacteriosis. The present review provides evidence of thermophilic Campylobacter occurrence in humans and animals and high levels of AMR in SSA, emphasizing the need for strengthening both national and regional multisectoral antimicrobial resistance standard surveillance protocols to curb both the campylobacteriosis burden and increase of antimicrobial resistance in the region.

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