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Geographical Accessibility to District Hospitals/Medical Laboratories for Comprehensive Antenatal Point-of-Care Diagnostic Services in the Upper East Region, Ghana.
EClinicalMedicine 2019 August
Background: Access to referral healthcare facilities from primary healthcare (PHC) clinics for diagnostic services is critical for improving maternal health outcomes. We described the geographical distribution and accessibility to district hospitals/medical laboratories for comprehensive antenatal point-of-care (POC) diagnostic services in the Upper East region (UER), Ghana.
Methods: We assembled detailed spatial data on 100 participated PHC clinics in our previous survey, their nearest referral district hospitals/medical laboratories, and landscape features influencing journeys in the UER. These were used in a geospatial model to estimate actual distance and travel time from a PHC facility to the nearest referral health facility for antenatal POC diagnostic services. Spatial distribution of the facilities was determined using spatial auto-correlation tool run in ArcMap 10.4.1. We employed Stata V14 for all other analysis.
Findings: Of the 100 PHC clinics included in the analysis, only 15% were located less than 10 km to their nearest referral health facilities. The mean distance ± standard deviation from a PHC clinic to the nearest referral district hospital/medical laboratory for comprehensive antenatal POC diagnostic services was 7.0 km ± 4.9. Whilst the mean travel time using a motorized tricycle speed of 20 km/h to the nearest referral health facility for comprehensive antenatal POC diagnostic was 14.0 min ± 8.8. The spatial auto-correlation results for the PHC clinics suggested that the PHC clinics were spatially distributed at random rather than clustered (MI = 0.01, z-score = 0.33, p = 0.74). Whereas the spatial distribution of the referral health facilities suggested that the hospitals or medical laboratories were spatially dispersed (MI = - 0.69 z-score = - 2.05, p = 0.04).
Interpretation: Although there is moderate geographical accessibility to district hospitals/medical laboratories for comprehensive antenatal diagnostic services in the UER, targeted improvement of POC diagnostic services in PHC clinics is recommended for improved maternal healthcare.
Funding: University of KwaZulu-Natal, College of Health Sciences Research Scholarship.
Methods: We assembled detailed spatial data on 100 participated PHC clinics in our previous survey, their nearest referral district hospitals/medical laboratories, and landscape features influencing journeys in the UER. These were used in a geospatial model to estimate actual distance and travel time from a PHC facility to the nearest referral health facility for antenatal POC diagnostic services. Spatial distribution of the facilities was determined using spatial auto-correlation tool run in ArcMap 10.4.1. We employed Stata V14 for all other analysis.
Findings: Of the 100 PHC clinics included in the analysis, only 15% were located less than 10 km to their nearest referral health facilities. The mean distance ± standard deviation from a PHC clinic to the nearest referral district hospital/medical laboratory for comprehensive antenatal POC diagnostic services was 7.0 km ± 4.9. Whilst the mean travel time using a motorized tricycle speed of 20 km/h to the nearest referral health facility for comprehensive antenatal POC diagnostic was 14.0 min ± 8.8. The spatial auto-correlation results for the PHC clinics suggested that the PHC clinics were spatially distributed at random rather than clustered (MI = 0.01, z-score = 0.33, p = 0.74). Whereas the spatial distribution of the referral health facilities suggested that the hospitals or medical laboratories were spatially dispersed (MI = - 0.69 z-score = - 2.05, p = 0.04).
Interpretation: Although there is moderate geographical accessibility to district hospitals/medical laboratories for comprehensive antenatal diagnostic services in the UER, targeted improvement of POC diagnostic services in PHC clinics is recommended for improved maternal healthcare.
Funding: University of KwaZulu-Natal, College of Health Sciences Research Scholarship.
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