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McCormick I, Nesemann JM, Zhao J, Mdala S, Kitema GF, Mwangi N, Gichangi M, Tang K, Burton MJ, Ramke J. Travel time to cataract surgical services in Kenya, Malawi and Rwanda: demonstrating a standardised indicator of physical access to cataract surgery. Eye (Lond) 2024; 38:2195-2202. [PMID: 37853109 PMCID: PMC11269656 DOI: 10.1038/s41433-023-02790-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Travel time can be used to assess health services accessibility by reflecting the proximity of services to the people they serve. We aimed to demonstrate an indicator of physical access to cataract surgery and identify subnational locations where people were more at risk of not accessing cataract surgery. METHODS We used an open-access inventory of public health facilities plus key informants in Kenya, Malawi and Rwanda to compile a geocoded inventory of cataract facilities. For each country, gridded estimates of the population aged ≥ 50 years and a travel-time friction surface were combined and a least-cost-path algorithm applied to estimate the shortest travel time between each grid and the nearest cataract facility. We categorised continuous travel time by 1-, 2- and 3 h thresholds and calculated the proportion of the population in each category. RESULTS At the national level, the proportion of the population aged ≥ 50 years within 2 h travel time to permanent cataract surgical services was 97.2% in Rwanda (n = 10 facilities), 93.5% in Kenya (n = 74 facilities) and 92.0% in Malawi (n = 6 facilities); this reduced to 77.5%, 84.1% and 52.4% within 1 h, respectively. The least densely populated subnational regions had the poorest access to cataract facilities in Malawi (0.0%) and Kenya (1.9%). CONCLUSION We demonstrated an indicator of access that reflects the distribution of the population at risk of age-related cataract and identifies regions that could benefit from more accessible services. This indicator provides additional demand-side context for eye health planning and supports WHO's goal of advancing integrated people-centred eye care.
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Affiliation(s)
- Ian McCormick
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - John M Nesemann
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- University of California San Francisco, Department of Ophthalmology, San Francisco, CA, USA
| | - Jinfeng Zhao
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Shaffi Mdala
- Kamuzu University of Health Sciences, Blantyre, Malawi
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Gatera Fiston Kitema
- Ophthalmology Department, School of Health Sciences, University of Rwanda, Kigali, Rwanda
| | | | - Michael Gichangi
- Ophthalmic Services Unit, Kenya Ministry of Health, Nairobi, Kenya
| | - Kevin Tang
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Jacqueline Ramke
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, UK
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
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García GA, Janko M, Hergott DEB, Donfack OT, Smith JM, Mba Eyono JN, DeBoer KR, Nguema Avue RM, Phiri WP, Aldrich EM, Schwabe C, Stabler TC, Rivas MR, Cameron E, Guerra CA, Cook J, Kleinschmidt I, Bradley J. Identifying individual, household and environmental risk factors for malaria infection on Bioko Island to inform interventions. Malar J 2023; 22:72. [PMID: 36859263 PMCID: PMC9979414 DOI: 10.1186/s12936-023-04504-7] [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: 08/08/2022] [Accepted: 02/18/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Since 2004, malaria transmission on Bioko Island has declined significantly as a result of the scaling-up of control interventions. The aim of eliminating malaria from the Island remains elusive, however, underscoring the need to adapt control to the local context. Understanding the factors driving the risk of malaria infection is critical to inform optimal suits of interventions in this adaptive approach. METHODS This study used individual and household-level data from the 2015 and 2018 annual malaria indicator surveys on Bioko Island, as well as remotely-sensed environmental data in multilevel logistic regression models to quantify the odds of malaria infection. The analyses were stratified by urban and rural settings and by survey year. RESULTS Malaria prevalence was higher in 10-14-year-old children and similar between female and male individuals. After adjusting for demographic factors and other covariates, many of the variables investigated showed no significant association with malaria infection. The factor most strongly associated was history of travel to mainland Equatorial Guinea (mEG), which increased the odds significantly both in urban and rural settings (people who travelled had 4 times the odds of infection). Sleeping under a long-lasting insecticidal net decreased significantly the odds of malaria across urban and rural settings and survey years (net users had around 30% less odds of infection), highlighting their contribution to malaria control on the Island. Improved housing conditions indicated some protection, though this was not consistent across settings and survey year. CONCLUSIONS Malaria risk on Bioko Island is heterogeneous and determined by a combination of factors interacting with local mosquito ecology. These interactions grant further investigation in order to better adapt control according to need. The single most important risk factor identified was travel to mEG, in line with previous investigations, and represents a great challenge for the success of malaria control on the Island.
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Affiliation(s)
| | - Mark Janko
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Dianna E B Hergott
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Wonder P Phiri
- MCD Global Health, Bioko Island, Malabo, Equatorial Guinea
| | | | | | - Thomas C Stabler
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matilde Riloha Rivas
- Equatorial Guinea Ministry of Health and Social Welfare, Bioko Island, Malabo, Equatorial Guinea
| | - Ewan Cameron
- Telethon Kids Institute, Perth Children's Hospital, Perth, Australia
| | | | - Jackie Cook
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Immo Kleinschmidt
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
- School of Pathology, Faculty of Health Science, Wits Institute for Malaria Research, University of Witwatersrand, Johannesburg, South Africa
| | - John Bradley
- MRC International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
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Dotse-Gborgbortsi W, Tatem AJ, Matthews Z, Alegana VA, Ofosu A, Wright JA. Quality of maternal healthcare and travel time influence birthing service utilisation in Ghanaian health facilities: a geographical analysis of routine health data. BMJ Open 2023; 13:e066792. [PMID: 36657766 PMCID: PMC9853258 DOI: 10.1136/bmjopen-2022-066792] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To investigate how the quality of maternal health services and travel times to health facilities affect birthing service utilisation in Eastern Region, Ghana. DESIGN The study is a cross-sectional spatial interaction analysis of birth service utilisation patterns. Routine birth data were spatially linked to quality care, service demand and travel time data. SETTING 131 Health facilities (public, private and faith-based) in 33 districts in Eastern Region, Ghana. PARTICIPANTS Women who gave birth in health facilities in the Eastern Region, Ghana in 2017. OUTCOME MEASURES The count of women giving birth, the quality of birthing care services and the geographic coverage of birthing care services. RESULTS As travel time from women's place of residence to the health facility increased up to two2 hours, the utilisation rate markedly decreased. Higher quality of maternal health services haves a larger, positive effect on utilisation rates than service proximity. The quality of maternal health services was higher in hospitals than in primary care facilities. Most women (88.6%) travelling via mechanised transport were within two2 hours of any birthing service. The majority (56.2%) of women were beyond the two2 -hour threshold of critical comprehensive emergency obstetric and newborn care (CEmONC) services. Few CEmONC services were in urban centres, disadvantaging rural populations. CONCLUSIONS To increase birthing service utilisation in Ghana, higher quality health facilities should be located closer to women, particularly in rural areas. Beyond Ghana, routinely collected birth records could be used to understand the interaction of service proximity and quality.
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Affiliation(s)
| | - Andrew J Tatem
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
| | - Zoe Matthews
- Department of Social Statistics and Demography, University of Southampton, Southampton, UK
| | - Victor A Alegana
- Population Health Unit-Wellcome Trust Research Programme, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anthony Ofosu
- Headquarters, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Jim A Wright
- School of Geography and Environmental Science, University of Southampton, Southampton, UK
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Tatem AJ. Small area population denominators for improved disease surveillance and response. Epidemics 2022; 41:100641. [PMID: 36228440 PMCID: PMC9534780 DOI: 10.1016/j.epidem.2022.100641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/12/2022] [Accepted: 10/04/2022] [Indexed: 12/29/2022] Open
Abstract
The Covid-19 pandemic has highlighted the value of strong surveillance systems in supporting our abilities to respond rapidly and effectively in mitigating the impacts of infectious diseases. A cornerstone of such systems is basic subnational scale data on populations and their demographics, which enable the scale of outbreaks to be assessed, risk to specific groups to be determined and appropriate interventions to be designed. Ongoing weaknesses and gaps in such data have however been highlighted by the pandemic. These can include outdated or inaccurate census data and a lack of administrative and registry systems to update numbers, particularly in low and middle income settings. Efforts to design and implement globally consistent geospatial modelling methods for the production of small area demographic data that can be flexibly integrated into health-focussed surveillance and information systems have been made, but these often remain based on outdated population data or uncertain projections. In recent years, efforts have been made to capitalise on advances in computing power, satellite imagery and new forms of digital data to construct methods for estimating small area population distributions across national and regional scales in the absence of full enumeration. These are starting to be used to complement more traditional data collection approaches, especially in the delivery of health interventions, but barriers remain to their widespread adoption and use in disease surveillance and response. Here an overview of these approaches is presented, together with discussion of future directions and needs.
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Affiliation(s)
- A J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, UK
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Tatem AJ. Small area population denominators for improved disease surveillance and response. Epidemics 2022; 40:100597. [PMID: 35749928 PMCID: PMC9212890 DOI: 10.1016/j.epidem.2022.100597] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022] Open
Abstract
The Covid-19 pandemic has highlighted the value of strong surveillance systems in supporting our abilities to respond rapidly and effectively in mitigating the impacts of infectious diseases. A cornerstone of such systems is basic subnational scale data on populations and their demographics, which enable the scale of outbreaks to be assessed, risk to specific groups to be determined and appropriate interventions to be designed. Ongoing weaknesses and gaps in such data have however been highlighted by the pandemic. These can include outdated or inaccurate census data and a lack of administrative and registry systems to update numbers, particularly in low and middle income settings. Efforts to design and implement globally consistent geospatial modelling methods for the production of small area demographic data that can be flexibly integrated into health-focussed surveillance and information systems have been made, but these often remain based on outdated population data or uncertain projections. In recent years, efforts have been made to capitalise on advances in computing power, satellite imagery and new forms of digital data to construct methods for estimating small area population distributions across national and regional scales in the absence of full enumeration. These are starting to be used to complement more traditional data collection approaches, especially in the delivery of health interventions, but barriers remain to their widespread adoption and use in disease surveillance and response. Here an overview of these approaches is presented, together with discussion of future directions and needs.
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Affiliation(s)
- A J Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, UK
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Towards an Improved Large-Scale Gridded Population Dataset: A Pan-European Study on the Integration of 3D Settlement Data into Population Modelling. REMOTE SENSING 2022. [DOI: 10.3390/rs14020325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Large-scale gridded population datasets available at the global or continental scale have become an important source of information in applications related to sustainable development. In recent years, the emergence of new population models has leveraged the inclusion of more accurate and spatially detailed proxy layers describing the built-up environment (e.g., built-area and building footprint datasets), enhancing the quality, accuracy and spatial resolution of existing products. However, due to the consistent lack of vertical and functional information on the built-up environment, large-scale gridded population datasets that rely on existing built-up land proxies still report large errors of under- and overestimation, especially in areas with predominantly high-rise buildings or industrial/commercial areas, respectively. This research investigates, for the first time, the potential contributions of the new World Settlement Footprint—3D (WSF3D) dataset in the field of large-scale population modelling. First, we combined a Random Forest classifier with spatial metrics derived from the WSF3D to predict the industrial versus non-industrial use of settlement pixels at the Pan-European scale. We then examined the effects of including volume and settlement use information into frameworks of dasymetric population modelling. We found that the proposed classification method can predict industrial and non-industrial areas with overall accuracies and a kappa-coefficient of ~84% and 0.68, respectively. Additionally, we found that both, integrating volume and settlement use information considerably increased the accuracy of population estimates between 10% and 30% over commonly employed models (e.g., based on a binary settlement mask as input), mainly by eliminating systematic large overestimations in industrial/commercial areas. While the proposed method shows strong promise for overcoming some of the main limitations in large-scale population modelling, future research should focus on improving the quality of the WFS3D dataset and the classification method alike, to avoid the false detection of built-up settlements and to reduce misclassification errors of industrial and high-rise buildings.
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