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de Carvalho Dutra A, Silva LL, dos Santos AGA, do Lago Franco R, Forato GAC, Bergamini M, Borba IM, de Campos EV, Staton CA, Marquezoni DP, Nihei OK, Vissoci JRN, de Andrade L. Bayesian Modeling and Estimation of Spatial Risk for Hospitalization and Mortality from Ischemic Heart Disease in Paraná, Brazil. Glob Heart 2024; 19:63. [PMID: 39132013 PMCID: PMC11312845 DOI: 10.5334/gh.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 07/24/2024] [Indexed: 08/13/2024] Open
Abstract
Objective Despite significant advancements in understanding risk factors and treatment strategies, ischemic heart disease (IHD) remains the leading cause of mortality worldwide, particularly within specific regions in Brazil, where the disease is a burden. Therefore, the aim of this study was to estimate the risk of hospitalization and mortality from IHD in the state of Paraná (Brazil), using spatial analysis to identify areas with higher risk based on socioeconomic, demographic and health variables. Methods This is an ecological study based on secondary and retrospective IHD hospitalization and mortality data obtained from the Brazilian Hospitalization and Mortality Information Systems during the 2010-2021 period. Data were analyzed for 399 municipalities and 22 health regions in the state of Paraná. To assess the spatial patterns of the disease and identify relative risk (RR) areas, we constructed a risk model by Bayesian inference using the R-INLA and SpatialEpi packages in R software. Results A total of 333,229 hospitalizations and 73,221 deaths occurred in the analyzed period, and elevated RR of hospitalization (RR = 27.412, CI 21.801; 34.466) and mortality (RR = 15.673, CI 2.148; 114.319) from IHD occurred in small-sized municipalities. In addition, medium-sized municipalities also presented elevated RR of hospitalization (RR = 6.533, CI 1.748; 2.006) and mortality (RR = 6.092, CI 1.451; 2.163) from IHD. Hospitalization and mortality rates were higher in white men aged 40-59 years. A negative association was found between Municipal Performance Index (IPDM) and IHD hospitalization and mortality. Conclusion Areas with increased risk of hospitalization and mortality from IHD were found in small and medium-sized municipalities in the state of Paraná, Brazil. These results suggest a deficit in health care attention for IHD cases in these areas, potentially due to a low distribution of health care resources.
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Affiliation(s)
| | - Lincoln Luis Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
| | | | | | | | - Marcela Bergamini
- Post-Graduation Program in Health Sciences, State University of Maringa, Parana, Brazil
| | | | | | - Catherine Ann Staton
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | | | - Oscar Kenji Nihei
- Education, Letters and Health Center, State University of the West of Paraná, Foz do Iguaçu, Paraná, Brazil
| | | | - Luciano de Andrade
- Post-Graduation Program in Health Sciences, State University of Maringa, Parana, Brazil
- Department of Medicine, State University of Maringa, Maringa, Parana, Brazil
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Exploring the barriers and facilitators to accessing and utilising mental health services in regional, rural, and remote Australia: A scoping review protocol. PLoS One 2022; 17:e0278606. [PMID: 36490232 PMCID: PMC9733872 DOI: 10.1371/journal.pone.0278606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Australians from regional, rural, and remote areas face diverse and complex challenges in accessing and utilising mental health services. Previous research has pointed to a range of individual, community, structural, and systemic barriers at play, however, limited literature has synthesised the knowledge on this topic. Parallel to this, information on the facilitators to accessing and utilising mental health services for this group is not well documented. This protocol describes the methodology to undertake a scoping review, which aims to explore the barriers and facilitators associated with accessing and utilising mental health services in regional, rural, and remote Australia. In addition, the scoping review aims to geographically map the identified barriers and facilitators. METHODS This protocol is guided by Arksey and O'Malley's methodological framework. A search strategy will be developed and implemented to identify relevant peer-reviewed and grey literature. Studies will be included if they report on the barriers and/or facilitators associated with accessing and/or utilising mental health services in regional, rural, and remote Australia. Two reviewers will independently screen the data at the title/abstract and full-text stage. One reviewer will extract the relevant data using a predetermined charting form and a second reviewer will validate the included data. A Geographical Information System program will be used to map the location of the studies; locations will be stratified according to the Modified Monash Model and relationships between barriers and facilitators will be analysed. Key findings will be presented in a narrative account and in text, tables, and maps. DISCUSSION This scoping review will provide a contemporary account on the barriers and facilitators to accessing and utilising mental health services for regional, rural, and remote Australians. It is anticipated that the results of this scoping review will have national policy relevance and may be useful to healthcare providers.
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Firouraghi N, Mohammadi A, Hamer DH, Bergquist R, Mostafavi SM, Shamsoddini A, Raouf-Rahmati A, Fakhar M, Moghaddas E, Kiani B. Spatio-temporal visualisation of cutaneous leishmaniasis in an endemic, urban area in Iran. Acta Trop 2022; 225:106181. [PMID: 34678259 DOI: 10.1016/j.actatropica.2021.106181] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/29/2021] [Accepted: 10/02/2021] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Cutaneous Leishmaniasis (CL) is a significant public health concern worldwide. Iran is among the most CL-affected countries, being one of the six most endemic countries in the world. This study aimed to provide a spatio-temporal visualisation of CL cases in an endemic urban area in north-eastern Iran identifying high-risk and low-risk areas during the period 2016-2019. METHODS This ecological study was conducted in the city of Mashhad, north-eastern Iran. All cases (n=2425) were diagnosed based on clinical findings and parasitological tests. The patient data were aggregated at the census tract level (the highest resolution available). CL incidence rates were subjected to Empirical Bayesian smoothing across the census tracts followed by spatial autocorrelation analysis to identify clusters and outliers. Spatial scan statistic was used to explore the purely temporal, purely spatial and spatio-temporal trend of the disease. In all instances, the null hypothesis of no clusters was rejected at p ≤0.05. RESULTS The overall crude incidence rate decreased from 34.6 per 100,000 individuals in 2016 to 19.9 per 100,000 in 2019. Cluster analysis identified high-risk areas in south-western Mashhad and low-risk areas in the north-eastern areas. Purely time scan statistics identified March to July as the time period with highest risk for CL occurrence. One most likely purely high-risk spatial cluster and six secondary purely high-risk spatial clusters were identified. Further, two spatio-temporal high-risk clusters, one in the north of the city from April to August and a second in the south-western part from March to September were observed. CONCLUSIONS Significant spatial, temporal and spatio-temporal patterns of CL distribution were observed in the study area, which should be considered when designing tailored interventions, such as effective resource allocation models, informed control plans and implementation of efficient surveillance systems. Furthermore, this study generated new hypotheses to test potential relationships between socio-economic and environmental risk factors and incidence of CL in high-risk areas.
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Affiliation(s)
- Neda Firouraghi
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Mohammadi
- Department of Geography and Urban Planning, Faculty of Social Sciences, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health; Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Robert Bergquist
- Swiss Tropical and Public Health Institute. Ingerod, Brastad, SE-454 94, Sweden (Formerly UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization), Geneva, Switzerland
| | - Sayyed Mostafa Mostafavi
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Shamsoddini
- Department of Human Geography, Faculty of Humanities, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran
| | - Amene Raouf-Rahmati
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Fakhar
- Department of Health and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Moghaddas
- Department of Parasitology and Mycology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Kiani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Sutarsa N, Banfield M, Passioura J, Konings P, Moore M. Spatial inequities of mental health nurses in rural and remote Australia. Int J Ment Health Nurs 2021; 30:167-176. [PMID: 32808431 DOI: 10.1111/inm.12769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Abstract
Despite an increased burden from chronic mental health conditions, access to effective mental health services in rural and remote areas is limited, and these services remain spatially undefined. We examine the spatial availability of mental health nurses across local government areas in Australia and identify gaps in mental health service delivery capacity in a finer-grained level than the state/territory data. A spatial distribution of mental health nurses was conducted. We utilized the 2017 National Health Workforce Dataset which was aggregated to LGA level based on the 2018 Australian Bureau Statistics (ABS) Data. The availability of mental health nurses was measured using the full time equivalent (FTE) rates per 100 000 population. We calculated the proportion of LGAs with zero total FTE rates based on remoteness categories. We also compared the mean of total FTE rates based on remoteness categories using analysis of variance. A spatial distribution of mental health nurses was visualized using GIS software for total FTE rates. Our analysis included 544 LGA across Australia, with 24.8% being defined as remote and very remote. The mean total FTE for mental health nurses per 100 000 populations is 56.6 (±132.2) with a median of 17.4 (IQR: 61.8). A wide standard deviation reflects unequal distribution of mental health nurses across LGAs. The availability of total FTE rates for mental health nurses per 100 000 populations is significantly lower in remote and very remote LGAs in comparison with major cities. As many as 35.1% of LGAs across Australia have no FTE for mental health nurses with 46% are remote and very remote. Our study reflects the existing unequal distribution of mental health nurses between metropolitan/urban setting and rural and remote areas. We suggest three broad strategies to address these spatial inequities: improving supply and data information systems; revisiting task-shifting strategies, retraining the existing health workforce to develop skills necessary for mental health care to rural and remote communities; and incorporating the provision of mental health services within expanding innovative delivery models including consumer-led, telemedicine and community-based groups.
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Affiliation(s)
- Nyoman Sutarsa
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia.,Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
| | - Michelle Banfield
- Centre for Mental Health Research, Research School of Population Health, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Jason Passioura
- National Centre for Geographic Resources and Analysis in Primary Health Care, Research School of Population Health, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Paul Konings
- National Centre for Geographic Resources and Analysis in Primary Health Care, Research School of Population Health, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Malcolm Moore
- Rural Clinical School, Medical School, College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
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Adams AM, Ahmed R, Ahmed S, Yusuf SS, Islam R, Zakaria Salam RM, Panciera R. Modelling improved efficiency in healthcare referral systems for the urban poor using a geo-referenced health facility data: the case of Sylhet City Corporation, Bangladesh. BMC Public Health 2020; 20:1476. [PMID: 32993610 PMCID: PMC7526238 DOI: 10.1186/s12889-020-09594-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
Background An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours. Methods Road network and geo-referenced facility census data from Sylhet City Corporation were used to examine referral linkages between public, private and NGO facilities for maternal and emergency/critical care services, respectively. Geographic distances were calculated using ArcGIS Network Analyst extension through a “distance matrix” which was imported into a relational database. For each reported referral linkage, an alternative referral destination was identified that provided the same service at a closer distance as indicated by facility geo-location and distance analysis. Independent sample t-tests with unequal variances were performed to analyze differences in distance for each alternate scenario modelled. Results The large majority of reported referrals were received by public facilities. Taking into account distance, cost and hours of service, alternative scenarios for emergency services can augment referral efficiencies by 1.5–1.9 km (p < 0.05) compared to 2.5–2.7 km in the current scenario. For maternal health services, modeled alternate referrals enabled greater referral efficiency if directed to private and NGO-managed facilities, while still ensuring availability after working-hours. These referral alternatives also decreased the burden on Sylhet City’s major public tertiary hospital, where most referrals were directed. Nevertheless, associated costs may be disadvantageous for the urban poor. Conclusions For both maternal and emergency/critical care services, significant distance reductions can be achieved for public, NGO and private facilities that avert burden on Sylhet City’s largest public tertiary hospital. GIS-informed analyses can help strengthen coordination between service providers and contribute to more effective and equitable referral systems in Bangladesh and similar countries.
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Affiliation(s)
- Alayne M Adams
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, 5858 Cote des Neiges, Room 332, Montréal, H3S 1Z1, Québec, Canada. .,Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.
| | - Rushdia Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - Shakil Ahmed
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | | | - Rubana Islam
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Rocco Panciera
- Implementation Research and Delivery Science Unit, Health Section, UNICEF, New York, NY, USA
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Stewart K, Li M, Xia Z, Adewole SA, Adeyemo O, Adebamowo C. Modeling spatial access to cervical cancer screening services in Ondo State, Nigeria. Int J Health Geogr 2020; 19:28. [PMID: 32693815 PMCID: PMC7374833 DOI: 10.1186/s12942-020-00222-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Women in low- and middle-income countries (LMIC) remain at high risk of developing cervical cancer and have limited access to screening programs. The limits include geographical barriers related to road network characteristics and travel behaviors but these have neither been well studied in LMIC nor have methods to overcome them been incorporated into cervical cancer screening delivery programs. METHODS To identify and evaluate spatial barriers to cervical cancer prevention services in Ondo State, Nigeria, we applied a Multi-Mode Enhanced Two-Step Floating Catchment Area model to create a spatial access index for cervical cancer screening services in Ondo City and the surrounding region. The model used inputs that included the distance between service locations and population centers, local population density, quantity of healthcare infrastructures, modes of transportation, and the travel time budgets of clients. Two different travel modes, taxi and mini bus, represented common modes of transit. Geocoded client residential locations were compared to spatial access results to identify patterns of spatial access and estimate where gaps in access existed. RESULTS Ondo City was estimated to have the highest access in the region, while the largest city, Akure, was estimated to be in only the middle tier of access. While 73.5% of clients of the hospital in Ondo City resided in the two highest access zones, 21.5% of clients were from locations estimated to be in the lowest access catchment, and a further 2.25% resided outside these limits. Some areas that were relatively close to cervical cancer screening centers had lower access values due to poor road network coverage and fewer options for public transportation. CONCLUSIONS Variations in spatial access were revealed based on client residential patterns, travel time differences, distance decay assumptions, and travel mode choices. Assessing access to cervical cancer screening better identifies potentially underserved locations in rural Nigeria that can inform plans for cervical cancer screening including new or improved infrastructure, effective resource allocation, introduction of service options for areas with lower access, and design of public transportation networks.
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Affiliation(s)
- Kathleen Stewart
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, MD, USA, 20742.
| | - Moying Li
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, MD, USA, 20742
| | - Zhiyue Xia
- Department of Geographical Sciences, Center for Geospatial Information Science, University of Maryland, College Park, MD, USA, 20742
| | - Stephen Ayodele Adewole
- Department of Obstetrics and Gynaecology, University of Medicine Teaching Hospital, Ondo, Nigeria
| | | | - Clement Adebamowo
- Department of Epidemiology and Public Health and Greenebaum Comprehensive Cancer Center, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Venkatraman C, Kim H, Idowu A, Idris J, Hynan L, Kim D, Nwariaku FE. When policy meets the pedal: A reduction in motorcyclist fatalities following the implementation of a road traffic law in Lagos, Nigeria. TRAFFIC INJURY PREVENTION 2019; 20:849-853. [PMID: 31647380 DOI: 10.1080/15389588.2019.1663346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/15/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023]
Abstract
Objective: The Lagos State Road Traffic Law of 2012 sought to curb reckless okada use and the objective of this study is to determine its impact on motorcyclist fatalities in Nigeria's most densely populated state. This is the first study to date that analyzes the potential impact of the Law on motorcyclist fatalities across Lagos State.Methods: We retrospectively reviewed monthly motorcyclist fatalities in Lagos between January 2012 and December 2015. We analyzed the data using Geographic Information Systems (GIS) software, and used Quantum GIS ver. 2.16.2 to create maps illustrating the spatial-epidemiological distribution of motorcyclist fatalities across Lagos' health facilities. The data was collated into three eight-month periods for analysis (pre-intervention, immediate post-intervention, and sustained post-intervention). Period 1 was January to August 2012, Period 2 was September 2012 to April 2013, and Period 3 was May to December 2013. The data were compared in SPSS using the Welch's ANOVA and Tanhame (post-hoc) tests with a 5% significance level.Results: Motorcyclist fatalities in Lagos fell by an average of 76% over the study period. Over 55% of the fatalities were recorded in five health facilities, located in an area of high road network density. The number of newly registered motorcycles also declined by an average of 69%. The Welch's ANOVA yielded a statistically significant difference between the Periods' means (p < 0.0001). The Tamhane post-hoc test showed significant differences in the mean decrease in fatalities between Period 1 and Period 2 (p = 0.002), and Period 1 and Period 3 (p < 0.0001).Conclusions: This study shows a significant decline in motorcyclist fatalities following the implementation of the Lagos State Road Traffic Law of 2012. A more comprehensive approach to data collection along with an updated law could contribute towards a sustainable reduction of motorcyclist mortality.
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Affiliation(s)
- Chinmayee Venkatraman
- Office of Global Health, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - HyoungAh Kim
- School of Economic, Political, and Policy Sciences, University of Texas at Dallas, Richardson, Texas
| | | | - Jide Idris
- Lagos State Ministry of Health, Lagos, Nigeria
| | - Linda Hynan
- Department of Clinical Science | Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dohyeong Kim
- School of Economic, Political, and Policy Sciences, University of Texas at Dallas, Richardson, Texas
| | - Fiemu E Nwariaku
- Office of Global Health, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Robin TA, Khan MA, Kabir N, Rahaman ST, Karim A, Mannan II, George J, Rashid I. Using spatial analysis and GIS to improve planning and resource allocation in a rural district of Bangladesh. BMJ Glob Health 2019; 4:e000832. [PMID: 31321091 PMCID: PMC6606075 DOI: 10.1136/bmjgh-2018-000832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 11/17/2022] Open
Abstract
The application of a geographic information system (GIS) in public health is relatively common in Bangladesh. However, the use of GIS for planning, monitoring and decision-making by local-level managers has not been well documented. This assessment explored how effectively local government health managers used maps with spatial data for planning, resource allocation and programme monitoring. The United States Agency for International Development-funded MaMoni Health Systems Strengthening project supported the introduction of the maps into district planning processes in 2015 and 2016. GIS maps were used to support the prioritisation of underserved unions (the lowest administrative units) and clusters of disadvantaged communities for the allocation of funds. Additional resources from local government budgets were allocated to the lowest performing unions for improving health facility service readiness and supervision. Using a mixed-methods approach, the project evaluated the outputs of this planning process. District planning reports, population-based surveys, local government annual expenditure reports and service availability and utilisation data were reviewed. The goal was to determine the degree to which district planning teams were able to use the maps for their intended purpose. Key informant interviews were conducted with upazila (subdistrict) managers, elected government representatives and service providers to understand how the maps were used, as well as to identify potential institutionalisation scopes. The project observed improvements in health service availability and utilisation in the highest priority unions in 2016. Quick processing of maps during planning sessions was challenging. Nevertheless, managers and participants expressed their satisfaction with the use of spatial analysis, and there was an expressed need for more web-based GIS both for improving community-level service delivery and for reviewing performance in monthly meetings. Despite some limitations, the use of GIS maps helped local health managers identify health service gaps, prioritise underserved unions and monitor results.
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Affiliation(s)
- T A Robin
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Marufa Aziz Khan
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Nazmul Kabir
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Sk Towhidur Rahaman
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Afsana Karim
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | | | - Joby George
- MaMoni Health Systems Strengthening Project, Save the Children International, Dhaka, Bangladesh
| | - Iftekhar Rashid
- United States Agency for International Development (USAID), Dhaka, Bangladesh
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Chowdhury AI, Abdullah AYM, Haider R, Alam A, Billah SM, Bari S, Rahman QSU, Jochem WC, Dewan A, El Arifeen S. Analyzing spatial and space-time clustering of facility-based deliveries in Bangladesh. Trop Med Health 2019; 47:44. [PMID: 31346313 PMCID: PMC6636060 DOI: 10.1186/s41182-019-0170-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/20/2019] [Indexed: 12/03/2022] Open
Abstract
Background A spatial and temporal study of the distribution of facility-based deliveries can identify areas of low and high facility usage and help devise more targeted interventions to improve delivery outcomes. Developing countries like Bangladesh face considerable challenges in reducing the maternal mortality ratio to the targets set by the Sustainable Development Goals. Recent studies have already identified that the progress of reducing maternal mortality has stalled. Giving birth in a health facility is one way to reduce maternal mortality. Methods Facility delivery data from a demographic surveillance site was analyzed at both village and Bari (comprising several households with same paternal origins) level to understand spatial and temporal heterogeneity. Global spatial autocorrelation was detected using Moran’s I index while local spatial clusters were detected using the local Getis Gi* statistics. In addition, space-time scanning using a discrete Poisson approach facilitated the identification of space-time clusters. The likelihood of delivering at a facility when located inside a cluster was calculated using log-likelihood ratios. Results The three cluster detection approaches detected significant spatial and temporal heterogeneity in the distribution of facility deliveries in the study area. The hot and cold spots indicated contiguous and relocation type diffusion and increased in number over the years. Space-time scanning revealed that when a parturient woman is located in a Bari inside the cluster, the likelihood of delivering at a health facility increases by twenty-seven times. Conclusions Spatiotemporal studies to understand delivery patterns are quite rare. However, in resource constraint countries like Bangladesh, detecting hot and cold spot areas can aid in the detection of diffusion centers, which can be targeted to expand regions with high facility deliveries. Places and periods with reduced health facility usages can be identified using various cluster detection techniques, to assess the barriers and facilitators in promoting health facility deliveries. Electronic supplementary material The online version of this article (10.1186/s41182-019-0170-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Atique Iqbal Chowdhury
- 1Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Yousuf Md Abdullah
- 2School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada
| | - Rafiqul Haider
- 1Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.,3Bureau of Meteorology, Collins St, Docklands, Australia
| | - Asraful Alam
- 1Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sk Masum Billah
- 1Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sanwarul Bari
- 1Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Qazi Sadeq-Ur Rahman
- 1Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Warren Christopher Jochem
- 4School of Geography & Environmental Science, University of Southampton, University Road, Southampton, UK
| | - Ashraf Dewan
- 5School of Earth and Planetary Sciences, Faculty of Science and Engineering, Curtin University, Bentley, Australia
| | - Shams El Arifeen
- 1Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Chowdhury AI, Haider R, Abdullah AYM, Christou A, Ali NA, Rahman AE, Iqbal A, Bari S, Hoque DME, Arifeen SE, Kissoon N, Larson CP. Using geospatial techniques to develop an emergency referral transport system for suspected sepsis patients in Bangladesh. PLoS One 2018; 13:e0191054. [PMID: 29338012 PMCID: PMC5770043 DOI: 10.1371/journal.pone.0191054] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Accepted: 12/27/2017] [Indexed: 11/25/2022] Open
Abstract
Background A geographic information system (GIS)-based transport network within an emergency referral system can be the key to reducing health system delays and increasing the chances of survival, especially during an emergency. We employed a GIS to design an emergency transport system for the rapid transfer of pregnant or early post-partum women, newborns, and children under 5 years of age with suspected sepsis under the Interrupting Pathways to Sepsis Initiative (IPSI) project. Methods A GIS database was developed by mapping the villages, roads, and relevant physical features of the study area. A travel-time algorithm was developed to incorporate the time taken by different modes of local transport to reach the health complexes. These were used in a network analysis to identify the shortest routes to the hospitals from the villages, which were categorized into green, yellow, and red zones based on their proximity to the nearest hospitals to provide transport facilities. An emergency call-in centre established for the project managed the transport system, and its data was used to assess the uptake of this transport system amongst distant communities. Results Fifteen pre-existing and two new routes were identified as the shortest routes to the health complexes. The call-in centre personnel used this route information to direct both patients and transport drivers to the nearest transport hubs or pick-up points. Adherence with referral advice was high in areas where the IPSI transport operated. Over the study period, the utilisation of the project’s transport doubled and referral compliance from distant zones similarly increased. Conclusions The GIS system created for this study facilitated rapid referral of patients in emergency from distant zones, using locally available transport and resources. The methodology described in this study to develop and implement an emergency transport system can be applied in similar, rural, low-income country settings.
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Affiliation(s)
- Atique Iqbal Chowdhury
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- * E-mail:
| | - Rafiqul Haider
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu Yousuf Md Abdullah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Aliki Christou
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nabeel Ashraf Ali
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ahmed Ehsnaur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Afrin Iqbal
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sanwarul Bari
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - D. M. Emdadul Hoque
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles P. Larson
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Dewan A, Abdullah AYM, Shogib MRI, Karim R, Rahman MM. Exploring spatial and temporal patterns of visceral leishmaniasis in endemic areas of Bangladesh. Trop Med Health 2017; 45:29. [PMID: 29167626 PMCID: PMC5686895 DOI: 10.1186/s41182-017-0069-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 09/21/2017] [Indexed: 01/09/2023] Open
Abstract
Background Visceral leishmaniasis is a considerable public health burden on the Indian subcontinent. The disease is highly endemic in the north-central part of Bangladesh, affecting the poorest and most marginalized communities. Despite the fact that visceral leishmaniasis (VL) results in mortality, severe morbidity, and socioeconomic stress in the region, the spatiotemporal dynamics of the disease have largely remained unexplored, especially in Bangladesh. Methods Monthly VL cases between 2010 and 2014, obtained from subdistrict hospitals, were studied in this work. Both global and local spatial autocorrelation techniques were used to identify spatial heterogeneity of the disease. In addition, a spatial scan test was used to identify statistically significant space-time clusters in endemic locations of Bangladesh. Results Global and local spatial autocorrelation indicated that the distribution of VL was spatially autocorrelated, exhibiting both contiguous and relocation-type of diffusion; however, the former was the main type of VL spread in the study area. The spatial scan test revealed that the disease had ten times higher incidence rate within the clusters than in non-cluster zones. Both tests identified clusters in the same geographic areas, despite the differences in their algorithm and cluster detection approach. Conclusion The cluster maps, generated in this work, can be used by public health officials to prioritize areas for intervention. Additionally, initiatives to control VL can be handled more efficiently when areas of high risk of the disease are known. Because global environmental change is expected to shift the current distribution of vectors to new locations, the results of this work can help to identify potentially exposed populations so that adaptation strategies can be formulated.
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Affiliation(s)
- Ashraf Dewan
- Department of Spatial Sciences, Curtin University, Perth, Australia
| | - Abu Yousuf Md Abdullah
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212 Bangladesh
| | | | - Razimul Karim
- Center for Environmental and Geographic Information Services (CEGIS), House: 06, Road No: 23/C, Dhaka, 1212 Bangladesh
| | - Md Masudur Rahman
- Department of Geography, South Dakota State University, South Dakota, USA
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