Geographical Access to Child and Family Healthcare Services and Hospitals for Africa-Born Migrants and Refugees in NSW, Australia; A Spatial Study

Background: African-born migrants and refugees arriving from fragile states and countries with political and economic challenges have unique health needs requiring tailored healthcare services and support. However, there is little investigation into the distribution of this population and their spatial access to healthcare in Australia. This paper reports on research that aimed to map the spatial distribution of Africa-born migrants from low and lower-middle-income countries (LLMICs) and refugees in New South Wales (NSW) and access to universal child and family health (CFH) services and hospitals. Methods: We analysed the Australian Bureau of Statistics 2016 Census data and Department of Social Services 2018 Settlement data. Using a Geographic Information System mapping software (Caliper Corporation. Newton, MA, USA), we applied data visualisation techniques to map the distribution of Africa-born migrants and refugees relative to CFH services and their travel distance to the nearest service. Results: Results indicate a spatial distribution of 51,709 migrants from LLMICs in Africa and 13,661 refugees from Africa live in NSW, with more than 70% of the total population residing in Sydney. The Africa-born migrant and refugee population in Sydney appear to be well served by CFH services and hospitals. However, there is a marked disparity between local government areas. For example, the local government areas of Blacktown and Canterbury-Bankstown, where the largest number of Africa-born migrants and refugees reside, have more uneven and widely dispersed services than those in Sydney’s inner suburbs. Conclusion: The place of residence and travel distance to services may present barriers to access to essential CFH services and hospitals for Africa-born refugees and migrants. Future analysis into spatial-access disadvantages is needed to identify how access to health services can be improved for refugees and migrants.

Spatial quality assessment of the pedestrian's environment using online digital tools

Tourist cities, in addition to offering places of attraction, must have quality spaces, with pedestrian-oriented infrastructure to ensure comfort, safety, accessibility, among other aspects that contribute to increasing local attractiveness. However, for this to happen, it is necessary that these cities know the reality of the pedestrian-oriented infrastructure available, through accurate surveys, which can be done on site and/or through online digital tools. In this context, this paper shows results from a study on the quality of pedestrian infrastructure on an important avenue in the tourist city of Barra Bonita, a city in the Midwest of São Paulo. The methodology incorporated the use of the spatial quality index of the pedestrian environment (IQEAP), developed by TONON (2019), and the virtual tools of Google Earth and Street View. The analysis of the results showed that the evaluated area has "Regular" IQEAP and, therefore, needs improvements in aspects involving the three pedestrian environment plans aimed at the pedestrian scale. The results also show negative aspects in relation to the virtual form of data survey (technical audit), which is not very accurate due to the dates of the images, absence of precision tools, and low image resolution. However, significant positive aspects can be highlighted, such as the reduction of survey time on site (in situ), and the use of fewer financial resources. Thus, this method can facilitate the survey of data in places of difficult geographical access, dispersed, large or distant areas, and thus become an innovative and practical option.

Equity of geographical access to public health facilities in Nepal

IntroductionGeographical accessibility is important against health equity, particularly for less developed countries as Nepal. It is important to identify the disparities in geographical accessibility to the three levels of public health facilities across Nepal, which has not been available.MethodsBased on the up-to-date dataset of Nepal formal public health facilities in 2021, we measured the geographical accessibility by calculating the travel time to the nearest public health facility of three levels (ie, primary, secondary and tertiary) across Nepal at 1×1 km2 resolution under two travel modes: walking and motorised. Gini and Theil L index were used to assess the inequality. Potential locations of new facilities were identified for best improvement of geographical efficiency or equality.ResultsBoth geographical accessibility and its equality were better under the motorised mode compared with the walking mode. If motorised transportation is available to everyone, the population coverage within 5 min to any public health facilities would be improved by 62.13%. The population-weighted average travel time was 17.91 min, 39.88 min and 69.23 min and the Gini coefficients 0.03, 0.18 and 0.42 to the nearest primary, secondary and tertiary facilities, respectively, under motorised mode. For primary facilities, low accessibility was found in the northern mountain belt; for secondary facilities, the accessibility decreased with increased distance from the district centres; and for tertiary facilities, low accessibility was found in most areas except the developed areas like zonal centres. The potential locations of new facilities differed for the three levels of facilities. Besides, the majority of inequalities of geographical accessibility were from within-province.ConclusionThe high-resolution geographical accessibility maps and the assessment of inequality provide valuable information for health resource allocation and health-related planning in Nepal.

Geospatial Analyses of Thyroid Cancer Incidence in Kelantan, Malaysia

Geographical Information System (GIS) has been widely used in evaluating health data. GIS-based disease mapping can act as a tool for an effective form of communication in public health and planning disease surveillance strategies. Yet, there is limited data on spatial distribution of cancer in Malaysia. In the present study, GIS was employed to map the thyroid cancer incidences, analyse the spatial distribution of the cases and assess their geographical accessibility to public hospitals. Registries of patients diagnosed with thyroid carcinoma from the year of 2013 to 2020 were retrieved and information regarding the year of diagnosis, age, gender, residential addresses and histological subtypes were obtained. The coordinates of residential addresses and public hospitals were obtained using Global Positioning System (GPS) and the radius of public hospitals were set within and beyond 10 km. Then, all data were inserted into ArcGIS 10.2 software and spatial analysis was performed. A total of 90 cases with thyroid carcinomas were recorded and mapped. The spatial distribution of thyroid cancer cases in Kelantan represented a clustered pattern (NNR: 0.549377, p-value <0.001) with most cases concentrated at northern part of Kelantan. Buffer analysis revealed that most of the cases (60%, 54 cases) were located within 10 km radius from public hospitals and the remaining 36 cases (40%) were situated beyond 10 km radius from public hospitals. In conclusion, thyroid cancer cases in Hospital USM were clustered with most cases concentrated at the northern part of the state. Majority of the cases have a good geographical access to public hospitals. These study findings provide useful information for health practitioners in planning public health intervention by targeting locations with poor geographical access to health facilities in order to improve overall health population in Kelantan.

Impact of Traffic Congestion on Spatial Access to Healthcare Services in Nairobi: an ecological study

Background Geographic accessibility is an important determinant of healthcare utilisation and is critical for achievement of universal health coverage. Despite the high disease burden and severe traffic congestion in many African cities, few studies have assessed how traffic congestion impacts geographical access to healthcare facilities and to health professionals in these settings. Methods Using data on health facilities obtained from the Ministry of Health in Kenya, we mapped 944 primary, 94 secondary and four tertiary healthcare facilities in Nairobi County. We then used traffic probe data to identify areas within a 15-, 30- and 45-minute drive from each health facility during peak and off-peak hours and calculated the proportion of the population with access to healthcare in the County. We employed a 2-step floating catchment area model to calculate the ratio of healthcare and healthcare professionals to population during these times. Results During peak hours, <70% of Nairobi’s 4.1 million population was within a 30-minute drive from a health facility. This increased to >75% during off-peak hours. In 45 minutes, the majority of the population had an accessibility index of one health facility accessible to more than 100 people (<0.01) for primary health care facilities while secondary and tertiary health facilities had a ratio of one health facility for more than 10,000 people (<0.0001) and at least two health facilities per 100,000 people (>0.00002) respectively. Of people with access to health facilities, a sub-optimal ratio of <2.3 healthcare professionals per 1000 people was observed in facilities offering primary and secondary healthcare during peak and off-peak hours. Conclusion These findings can guide urban planners and policymakers in improving access to healthcare facilities to optimise coverage during peak and off-peak traffic times. Similarly, growing availability of traffic probe data in African cities should enable similar analysis in other countries.

Epidemiological Health Information

Epidemiological health information is vital for planning and managing health services. This chapter examines importance of different diseases, local health surveillance systems and availability of data and how to use it. Information is reviewed for typical patterns of morbidity, mortality, and burden of disease. Local epidemiological data are useful to estimate expected numbers of cases, geographical access to health facilities, quality of services, and the coverage achieved for different programmes. Importance of understanding seasonality on health data and indicators of inequalities is explained. A local health information checklist is given.

Geographic and Temporal Access to Basic Banking Services Offered through Post Offices in Wales

Access to ‘universal banking services’ through the post office network has been a goal of the UK governments over the last twenty years. Various policies and mechanisms have been put in place in an attempt to maintain national geographical coverage with access points while increasing the financial viability of the network. One such mechanism is represented by the six official criteria for access to post offices, expressed as a percentage of the UK population living within one mile, three miles, and six miles of a post office. The method for calculating compliance with these access criteria is not published. Nor will any granular results be published, but only an annual statement that the criteria are being met. This article examines geographical and temporal access to post offices in order to understand the territorial coverage of the network and the impact this has on the provision of basic banking services. The area under investigation is Wales, for which we are reviewing the Government’s official access criteria. Through the Post Office Ltd website, we are collecting up-to-date information on the locations and opening hours of post offices in Wales. In addition, a detailed population grid is combined with calculated areas of equidistant geographical access, called isochrones, to determine the number of people who have access to the post office network. The isochrones are based on the Welsh road network and are calculated for different travel modes and thresholds using a powerful routing engine. Our results show that the official access criteria are largely unmet in Wales. In addition, and in contrast to previous studies, we show a rural-urban divide not in terms of spatial access, but in the combination of spatial and temporal access. The results are of both practical and theoretical value and will hopefully inform policy makers.

Geospatial analysis of pediatric surgical need and geographical access to care in Somaliland: a cross-sectional study

BackgroundThe global burden of disease in children is large and disproportionally affects low-income and middle-income countries (LMICs). Geospatial analysis offers powerful tools to quantify and visualise disparities in surgical care in LMICs. Our study aims to analyse the geographical distribution of paediatric surgical conditions and to evaluate the geographical access to surgical care in Somaliland.MethodsUsing the Surgeons OverSeas Assessment of Surgical Need survey and a combined survey from the WHO’s (WHO) Surgical Assessment Tool—Hospital Walkthrough and the Global Initiative for Children’s Surgery Global Assessment in Paediatric Surgery, we collected data on surgical burden and access from 1503 children and 15 hospitals across Somaliland. We used several geospatial tools, including hotspot analysis, service area analysis, Voronoi diagrams, and Inverse Distance Weighted interpolation to estimate the geographical distribution of paediatric surgical conditions and access to care across Somaliland.ResultsOur analysis suggests less than 10% of children have timely access to care across Somaliland. Patients could travel up to 12 hours by public transportation and more than 2 days by foot to reach surgical care. There are wide geographical disparities in the prevalence of paediatric surgical conditions and access to surgical care across regions. Disparities are greater among children travelling by foot and living in rural areas, where the delay to receive surgery often exceeds 3 years. Overall, Sahil and Sool were the regions that combined the highest need and the poorest surgical care coverage.ConclusionOur study demonstrated wide disparities in the distribution of surgical disease and access to surgical care for children across Somaliland. Geospatial analysis offers powerful tools to identify critical areas and strategically allocate resources and interventions to efficiently scale-up surgical care for children in Somaliland.

Barreras de acceso geográfico a los servicios de salud oral en el departamento del Tolima, Colombia.

Cross-sectional descriptive mixed study carried out for the 47 municipalities of the department of Tolima, Colombia, neighboring the department of Cundinamarca, where Bogota, the capital of the country, is located. The objective was to analyze the geographical access barriers and the inventory of human talent and dental services in this department. A distance and time measurement system was applied to identify the duration of travel from each municipality to Ibagué (departmental capital) by public transport. The geographical accessibility barrier determinant endorsed by the World Health Organization (W.H.O.) is a trip duration greater than four hours. It was found that the first level of care in the public sector is present in all municipalities, the second level is in six; the third only in Ibague. Displacement by public transport represents a geographical access barrier in six municipalities; the number of dentists in the public sector does not satisfactorily cover the needs of the population, since more than 50% of the municipalities have a deficit of more than four general dentists and there is a low presence of specialists. In the department of Tolima there are geographical accessibility barriers to health and, specifically, to oral health.